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Doping ‘legally’: What TUE is, how athletes use it

Hackers have released confidential medical records of top American athletes, alleging they play ‘well, but not fair’ — that is, they misuse an exemption meant for therapeutic use of drugs.

Written by Jonathan Selvaraj |
September 15, 2016 12:02:58 am
Serena Williams, Serena Williams doping, USA Rio Olympics, Rio Olympics, USA doping, Russia, Simone Biles, fancy bears, fancy bears hack, russia fancy bear, fancy bear hack, serena williams, venus williams, simone biles, doping usa, usa doping, Venus Williams, Serena Williams olympics, Fancy Bears, Russia TUE, sports news The athletes say they were permitted to use those substances through a system known as Therapeutic Use Exemption or TUE — which, according to Fancy Bears, means they “got their licences for doping”.

Three weeks after the USA ended the Rio Olympics with 46 gold, 37 silver, and 38 bronze medals, hackers calling themselves Fancy Bears have alleged that “the US team played well but not fair”. The group, believed to be based in Russia, also released illegally-accessed medical records Tuesday, purporting to show that superstar gymnast Simone Biles, who won four golds, and tennis players Venus and Serena Williams took substances on the banned list over the years, including during the Olympics.

The athletes say they were permitted to use those substances through a system known as Therapeutic Use Exemption or TUE — which, according to Fancy Bears, means they “got their licences for doping”.

So, were the Williams sisters and Biles doping?

Serena and Venus seem to have used a brew of substances including prednisone, prednisolone, methylprednisone, hydromorphone and oxycodone; Biles “methylphenidate and its metabolite Ritalinic Acid”. But even if the leaked documents are genuine, they are by themselves no proof of any violation of the WADA (World Anti Doping Agency) code. They would only show that the athletes were using substances for which they had a therapeutic use exemption (TUE) — which means is that while Biles and the Williams sisters were taking banned substances, they were doing so 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.

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Okay, but what exactly is a TUE?

While athletes may appear to be superhuman when they compete, they often have all too ordinary ailments. While most of us are able to treat these conditions using nothing more than a doctor’s prescription, it gets complicated for athletes. This is because medicines used to treat a prevailing condition might contain substances that are banned by WADA. A TUE grants athletes permission to take their required medicine. Biles, for instance, received a TUE for medication commonly used to treat attention-deficit hyperactivity disorder. The Williams sisters were being treated for injury during the period when they requested a TUE.

But isn’t there a possibility of an athlete claiming a TUE, using banned substances and getting away?

Not really. “It’s not that every banned substance can be used if you get a TUE. You can’t just get away by saying I have a medical condition that needs to be treated with a banned substance,” says Dr PSM Chandran, president of the Indian Federation of Sports Medicine and a former head of sports medicine at the Sports Authority of India. To get a TUE, athletes and their physicians have to fill in an application form provided by WADA, specifying the condition they face, and why a particular medication that contains a banned substance is specifically required. TUE exemptions must be constantly renewed. Medication and dosage must be specified in the form. Athletes who compete at the international level are required to submit their applications to the International Federation (IF) of their sport, which usually creates a panel of doctors to consider them. Athletes at the national level submit applications to their National Anti Doping Agency. Applications must be submitted at least 30 days before an event.

What role does WADA play in this?

After an IF grants a TUE, it has to inform WADA, which can review and reverse the decision. An athlete cannot apply to WADA directly. Fancy Bears’s allegation that WADA granted licences to permit doping is off the mark for this reason.

All this seems above board. So what is the problem?

In his book The Secret Race: Inside the Hidden World of the Tour de France, former American cyclist Tyler Hamilton explained how competitors used TUEs to hide unfair practices: “…Team doctors would invent some phantom problem — a bad knee, saddle sore — and write a note allowing you to use cortisone or some similar substance.”

Cortisone and corticosteroids — for which Serena and Venus tested positive — increase airflow to the lungs by opening the airways, and also reduce pain during high intensity exercise. That could explain why 60% of cyclists at the 2006 Tour de France were using TUEs.

Indeed the use of TUEs has been increasing steadily. 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.

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