First paragraph: Four-time Tour de France winnerChris Froome&rsquo;spositive test for high levels of the asthma drugsalbutamolin September during the Vuelta a Espana race has prompted much debate on the rules surrounding medicines in sport. In essence, some drugs are not allowed, and others are allowed up to a threshold level under aTherapeutic Use Exemption(TUE). This creates problems in establishing the threshold level and around accidental over-use, but also opens the door to unethical behaviour

Dimeo, Paul

Moller, Verner

Stirling Online Research Repository (RIOXX)

20/12/2017 Elite sport: time to scrap the therapeutic exemption system of banned medicineshttps://theconversation.com/elite-sport-time-to-scrap-the-therapeutic-exemption-system-of-banned-medicines-89252 1/4AuthorsPaul DimeoSenior Lecturer, Faculty of Health Sciencesand Sport, University of StirlingVerner MøllerProfessor of Sports Science, AarhusUniversityAcademic rigour, journalistic flairFour-time Tour de France winner Chris Froome’s positive test for high levels of theasthma drug salbutamol in September during the Vuelta a Espana race has promptedmuch debate on the rules surrounding medicines in sport.In essence, some drugs are not allowed, and others are allowed up to a threshold levelunder a Therapeutic Use Exemption (TUE). This creates problems in establishing thethreshold level and around accidental over-use, but also opens the door to unethicalbehaviour.Team Sky cyclist Froome, who did not have a TUE for salbutamol, but was using it undernormal guidelines that the World Anti-Doping Agency (WADA) allows, defended his useof the drug for treating his asthma and said he hadn’t broken any rules.This case and others throw up broader questions about how to regulate medical drug usein elite cycling.If an athlete has evidence from a doctor, they can be allowed to take a medical drug that is on the prohibited list via the TUE system. The idea, as Froome’s teammate Bradley Wiggins said in defencePA, CC BY-SADecember 18, 2017 4.30pm GMTElite sport: time to scrap the therapeutic exemption system ofbanned medicines20/12/2017 Elite sport: time to scrap the therapeutic exemption system of banned medicineshttps://theconversation.com/elite-sport-time-to-scrap-the-therapeutic-exemption-system-of-banned-medicines-89252 2/4of his own TUE for pollen allergies, is to level the playing field byremoving the disadvantage of an illness. However, taken in large doses,there are some medicines which also have stimulating effects – which iswhy they are banned.Given the potential for exploiting this loophole, and the lack ofconsistency, it might be fairer if the TUE system was completelyscrapped. This would also be in the interests of athletes’ short and long-term health.Taking advantage of the systemThere are many ways in which an unscrupulous and determined athletecan exploit the TUE process. An obvious strategy is to find a doctorwilling to bend the rules and write prescriptions for unnecessarymedicines. Another might be to fake an illness or manipulate the resultsof diagnostic tests.There is some research to show this may happening in practice. For example, in a large Danish study,51% of respondents believed that athletes in their sport where being allowed unnecessary TUEs.In November, Shane Sutton, the former Team Sky coach said that TUEs were part of their “marginalgains” performance strategy. The leading athletics coach, Alberto Salazar, who was until recentlyBritish distance runner Mo Farah’s coach, obtained TUEs for his group of elite athletes, and uponinvestigation it was revealed that some of their medical records were altered.There is a clear difference between the letter of the law and the spirit of the law, but in a highlycompetitive context like sport, managers will follow the letter of the law to avoid punishment whiletrying to gain as much advantage as possible.Salbutamol is a drug used to treat asthma. PA, CC BY-SA20/12/2017 Elite sport: time to scrap the therapeutic exemption system of banned medicineshttps://theconversation.com/elite-sport-time-to-scrap-the-therapeutic-exemption-system-of-banned-medicines-89252 3/4InconsistenciesThe purpose of allowing access to medicines ostensibly seems to be a supportive, athlete-centredpolicy. But if an athlete sprains their ankle they have no choice but to rest until it is healed. They aretreated unfairly compared to an athlete who has an illness for which there is a short-term cure.Another problem is that some athletes have medical support staff who know how to use the TUEsystem to their advantage. Someone in a less well-resourced environment might find it much harderto get good advice. In such a case, they might simply accept their fate and stop competing until theyhave recovered, or risk a sanction by inadvertently taking a banned drug without having applied for aTUE.Read more: World cycling is broken: it’s time to lift the ban on dopingOne might also imagine there are athletes who believe in the spirit of the law and the values of sport,and so refrain from over-medicalising even if they have the opportunity. They might wish todemonstrate their success is due to hard work, fitness and skill, not supported by artificial stimulants.The current policy is a compromise between not allowing too much drug use, and the hard line of ablanket no-drugs policy that would discriminate against athletes with treatable health issues. Yet,there is a range of unforeseen consequences if the drugs in question are not available to all athletes,and if there are opportunities to bend the rules.Effects on athletesBritish cyclist Chris Froome celebrates winning the Tour de France in 2015. PA, CC BY-SA20/12/2017 Elite sport: time to scrap the therapeutic exemption system of banned medicineshttps://theconversation.com/elite-sport-time-to-scrap-the-therapeutic-exemption-system-of-banned-medicines-89252 4/4Cycling Doping Elite sport Chris Froome Mo Farah World Anti-Doping Agency Bradley WigginsWhile the TUE system appears to be concerned about athletes’ health by allowing them to usemedicines, there are some ways in which the use of such medicines is detrimental to their health.If an athlete is ill or in pain, they should rest. Drugs whichmask a health problem in order to allow athletes to pushthemselves for the sake of sport could have an impact in theshort and longer term. The over-use of painkillers can lead toaddiction, as found recently in American football. Painkillersalso lead to neglecting the underlying medical problem,causing long-term health issues and shortening athletes’careers.If a new policy saw the scrapping of TUEs, athletes mightstill be allowed to use a selection of over-the-countermedicines in low doses. A list of such medicines could becompiled, ensuring there was no confusion about whichdrugs could be taken. This would help athletes of integritytrust the system to protect them from unscrupulous athletes,doctors and coaches.And if WADA aims to ensure a level playing field, promote the health of athletes and foster aconsistent, coherent and transparent approach, then perhaps the only way forward is to prevent theabuse of TUEs is by removing them completely.The global sports community needs to be serious about clean sport, and such a drastic solution mightbe necessary. Those who suffer illness might not get to compete to the same extent, but athletes wouldhave to accept that fairness and health are good principles to follow, and accept their fate much likeathletes who miss out due to broken bones or concussion.This might sound brutal and inhumane, and WADA might look for ways to soften the blow for thoseathletes in genuine need, but at the very least, we need to recognise the complex and sometimeshidden problems in the current approach, and seek ways to solve them.Help combat alt-facts and fake news and donate to independent journalism. Tax deductible.Make a donationSir Bradley Wiggins has benefited fromTUEs to help him deal with a pollen allergy.PA, CC BY-SA 

Elite sport: time to scrap the therapeutic exemption system of banned medicines

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Elite sport: time to scrap the therapeutic exemption system of banned medicines

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