Medical Opinion: Why details in pros’ leaked TUEs are worrying

Posted on: September 16th, 2016

Well known cycling doctor Conor McGrane, left, says the leaked details of substances taken under TUE by Wiggins and Froome are a cause for concern.

 

Dr Conor McGrane

In recent days hacked Therapuetic Use Exemptions (TUEs) details were leaked by a Russian based group called Fancy Bears.

Both Chris Froome and Bradley Wiggins were included in a list of world class athletes who were given exemptions to allow the use of corticosteroids.

TUEs were originally envisioned as a way of allowing athletes who had severe illnesses to take otherwise banned medications.

It is important to make clear that neither of these cyclists is accused of doing anything wrong. Their names should also have been kept confidential under the present system, as should the personal medical information leaked.

But the leaked information raises some questions.

Used properly, corticosteroids are powerful and potentially lifesaving drugs. In sport they are allowed out of competition but banned in, and for a period before, competition.

There are guidelines for their use but it seems that in sport, especially at elite world class level, they are being used far sooner and for milder illnesses than they should.

I will give two examples; asthma and hayfever.

For asthma, oral steroids should be used if there is a severe asthma attack.

This is when there is severe shortness of breath – inability to speak full sentences, peak expiratory flow rates (PEFRs) less than 50 per cent of normal and raised heart rates (above 110 at rest).

It seems they are being repeatedly used – and approved for use by the World cycling body the UCI – for much less serious episodes.

 

Chris Froome, above, has said he has no isssue with his TUE details being leaked online, which they were in recent days (Photo: Sirotti)

 

There is also a concern that there are being used to allow athletes continue in competitions when they are not medically fit to do so.

There are a number of world specialist bodies such as the British Thoracic Society who produce guidelines. In sport they seem to be ignored at best, and flouted at worst.

For allergies such as hayfever there are numerous modern, effective and safe treatments.

World specialist bodies such as the British Society for Allergy and Clinical Immunology state that steroid injections should be avoided in all but the most severe cases.

In my experience at national and elite national level, the Irish Sports Council and now Sport Ireland had a policy of refusing TUEs for injections in almost all cases.

This was due to the fact that risks involved are thought to far outweigh the benefits. In basic terms, it is akin to using a sledge hammer to put up a picture hook.

In health terms why are TUEs needed and why should their use be restricted though?

The risks from steroids include stomach ulcers, vomiting, mood , sleep and mental health disturbances and a higher risk of infection and breaking bones.

In the context of cycling though, the increased risk of osteoporosis is a particular worry.

As a “non load bearing” sport and one where athletes tend to have low body fat levels cyclists at elite level are already at a higher risk of osteopenia (thin bones) and the more severe osteoporosis (brittle bones).

This is while competing and indeed in later life. Taking high dose corticosteroids dramatically increases that risk.

There are also increased risks of joint problems such as avascular necrosis and osteoarthritis.

In my opinion there are problems here on a few different levels.

Are cyclists and athletes who are being prescribed these drugs being made aware of the risks, both immediate and possibly lifelong, from taking them?

Are doctors flouting the guidelines and if so why?

And why are bodies such as the UCI approving the use of these drugs in situations where Sports Ireland are (correctly in my opinion) refusing to do so?

WADA has a responsibility to protect both the integrity of sport and the health of athletes.

Without naming anyone, they could quite easily produce and publish a list of the number of TUEs received, the medications involved and the reasons they were given.

With this information the true extent of the issue would be made clear.

Without it, hacked details and innuendo will make many suspicious that overuse and indeed possible abuse of the TUE system and use of corticosteroids is a problem in sport.

Whatever about the possible illegal performance enhancing effects many will continue to be concerned that the health of cyclists are being put at risk.

  • Dr Conor McGrane is a cyclist and as well as running his own medical practice has worked with Cycling Ireland as a doctor. He writes here in a personal capacity.

 

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