Calls made for WADA to examine Wiggins TUE corticosteroid controversy
First Bradley Wiggins and then Dave Brailsford broke long silences in recent days, insisting that they did nothing wrong. The duo were speaking separately in relation to the administration of three corticosteroid injections before the 2011 and 2012 Tours de France and the 2013 Giro d’Italia, Wiggins’ prime targets in each of those seasons.
Their defence was simple. No rules were broken, each insisted, because others in authority gave a green light to receive the shots. We applied for Therapeutic Use Exemptions [TUEs], we got them, end of story.
Except it isn’t. There remains a lingering unease about the situation, not only amongst those who follow cycling but also mainstream journalists who covered the story and the public who follow it. When Team Sky was founded it promised to be whiter than white; at the very least, the injection of a powerful corticosteroid days before Wiggins’ 2012 Tour de France victory was dancing in the grey area.
The unease about the data exposed by Russian hackers is heightened by Wiggins’ insistence in his 2012 autobiography My Time that he had never received any injections, other than vaccinations and occasional drips. His attempt to explain away this inconsistency on Saturday appeared clumsy, while Brailsford’s claim not to know corticosteroids were performance-enhancing was similarly unconvincing.
Now calls have been made for WADA to look into the matter, with a cycling whistleblower and a federation doctor asking the anti-doping agency to examine the circumstances of those injections.
Former professional rider and admitted past doper Joerg Jaksche is one who has spoken about the use of the corticosteroid Triamcinolone acetonide, the substance given to Wiggins. He said earlier this month that it has potent performance enhancing effects and that riders in his era would deliberately exaggerate claims of illness or injury to get a TUE for it.
Speaking to CyclingTips this week, the German said that it was important to discern if Wiggins’ use of the corticosteroid was proportional and also correctly sanctioned.
“To be honest, I think WADA should investigate,” he said. “WADA should follow up this information. It should ask if there is a chance that somebody applied for this TUE for cortisone without having this disease, or without really needing to take this injection? That is the main thing for me.”
One worrying aspect of Wiggins’ explanation is that he finished fourth overall in the 2009 Tour de France while using only inhalers for his asthma. These are a milder form of treatment which don’t have the same performance boosting and weight reducing effects as injections.
The question exists: why were inhalers good enough in 2009, but not in 2011, 2012 and 2013?
In talking about the decision to seek a TUE for Triamcinolone acetonide, Wiggins said on Saturday that his breathing had been off in the build-up to those Grand Tours.
As several have pointed out, there is once again a contradiction contained within the pages of My Time.
“I’d done all the work, I was fine-tuned,” he stated there about the period before the 2012 Tour. “I was ready to go. My body was in good shape. I’m in the form of my life. I was only ill once or twice with minor colds, and I barely lost a day’s training from it.”
Indeed he won the Critérium du Dauphiné in both 2011 and 2012, finishing over a minute clear of his nearest rivals on both occasions. Reconciling this with his claims of breathing problems is difficult.
Jaksche said that proof should be provided at this point.
“We have to trust doctors that they don’t come up with a fake illness,” he said. “I had allergies and I went to a specialist and they would do [skin]prick tests and breathing tests. I am wondering where all this documentation is. There must be documentation.
“If you look at Calum Skinner’s case [note: Skinner is a Olympic gold-medal winning track sprinter who also had TUE files leaked], he has delivered all the information that he had dating back to when he was about five years of age. It is all justified and all good.
“Right now, Bradley Wiggins’ case looks more like, ‘ah, you have allergies, take cortisone and it can also help you for riding.’ It is a very weird situation. Without the documentation, I don’t trust them.
“We know Team Sky’s approach – marginal gains, testing everything, blah blah. If there is no documentation, it could be a false medical justification. In that case, you get punished with a four year ban.”
Jaksche is referring to the section of the UCI’s anti-doping rules setting out the regulations for the criteria for granting a Therapeutic Use Exemption.
These rules include the following:
2) The Rider would experience a significant impairment to health if the Prohibited Substance or Prohibited Method were to be withheld in the course of treating an acute or chronic medical condition.
3) The therapeutic use of the Prohibited Substance or Prohibited Method would produce no additional enhancement of performance other than that which might be anticipated by a return to a state of normal health following the treatment of a legitimate medical condition.
4) There is no reasonable therapeutic alternative to the use of the otherwise Prohibited Substance or Prohibited Method.
What this boils down to is simple: if injections were not necessary, if any breathing difficulties could have been eliminated by milder treatments, then Wiggins and the team may have broken the rules.
“The risk-benefit ratio for steroid injections is unacceptable”
Conor McGrane is a medical doctor based in Dublin, Ireland, and who has worked for many years as Cycling Ireland federation doctor. He has given his opinion on the Wiggins case and, like Jaksche, also has some concerns.
“It is very disappointing the way they have all reacted to it,” he said, referring to Wiggins and Brailsford. “I think Wiggins’ main problem is that he dug a hole for himself by releasing the autobiography with the comment on injections.
“Sky dug a hole for themselves by having comments made through David Walsh [the journalist who was embedded with the team and wrote Inside Team Sky – ed.] that they weren’t going to be using TUEs in competition and they weren’t going to be using things like cortisone. Then it turns out they obviously were.
“They are basically now saying, ‘well, we did everything within the rules and it is okay.’ I just think it is unfortunate when you see people pushing things towards the limit to the rules, and also using medications which are effective when they are used properly, but then using them for things that really don’t warrant it.”
McGrane points out that corticosteroid injections are not permitted by the Irish Sports Council, and that in medicine they are generally advised against due to health problems such as osteoporosis and avascular necrosis, as well as mood issues, psychological problems, plus sleep and weight disturbances.
“It is considered to be bad practice now,” he told CyclingTips. “Certainly with the use of modern medications and treatments, it is thought that there are any number of effective modern safe treatments out there. The actual phrase that is used [in medicine] is that the risk-benefit ratio for steroid injections is unacceptable.”
McGrane states that inhalers, the course of treatment used by Wiggins en route to fourth in the 2009 Tour, are generally effective at treating asthma and allergies. If the inhalers don’t work well enough for any reason, he points out there are other alternatives.
“You can use products such as anti-histamines and steroid nasal sprays for allergic rhinitis, and medications like Singulair to treat both asthma and allergies. These don’t have the same side-effects as steroids.
“There are strong guidelines from the British Association of Allergy and Clinical Immunology for the treatment of allergic rhinitis. They say quite clearly that injections should really only be used as a last resort, and even then that the side effects probably outweigh any beneficial effects.”
McGrane’s concerns are echoed by Dr Armand Megret, an expert for the Movement for Credible Cycling group.
“There is no logic in injecting yourself with Kenacort [Triamcinolone acetonide] before the start of a Grand Tour,” he told L’Equipe this week.
“It does not make sense that such a champion with such team with such an organized staff can take corticoids so casually.”
Like Jaksche, McGrane wants WADA to look into the matter.
“I think it is very fair to want that to happen,” he states. “On some levels we have to take it at face value that Wiggins applied for it, went through the proper circles, got approval for it and took it. I think we can theorise more than that, but they are effectively facts that we can state with certainty.
“But I think Joerg Jaksche’s suggestion is what needs to happen. I think that WADA needs to do two things. One, they need to publish anonymised data on TUEs granted for medications per sport and per region, so we can compare how many TUEs for cortisone have been granted in cycling compared to running compared to tennis. Also, how many are being issued from Russia compared to GB compared to Ireland. That is data that they could publish quite easily without identifying any athletes.
“And I also thing that we are really at a position where we need to have a clinical audit committee set up to examine the granting of TUEs. So it is not just the fact that you have a three panel committee examining each one. You really need to have a clinical committee reviewing the decisions of that committee each time. To make sure, one, that the committee met, that they all came to the decision, and also basically to see if they stand up at all, if they are consistent throughout sports and regions.”
“The TUE system looks like it is a nonsense”
When the Wiggins request was granted, there was the scope for a three-man committee to make judgements on TUEs. However in reality many TUEs were granted by the UCI’s-then scientific advisor and doctor Mario Zorzoli.
This happened when Team Sky’s Chris Froome was fast-tracked a TUE for the corticosteroid prednisolone prior to the 2014 Tour de Romandie. He complained of breathing problems and went on to win the event.
Zorzoli alone also signed off on Wiggins’ three TUE forms.
The doctor was suspended in January 2015 when, in the course of the investigation into former Rabobank doctor Geert Leinders, former pro Michael Rasmussen made claims against him.
Rasmussen said that after the UCI had raised issues in relation to his incriminating blood readings, that Leinders had met Zorzoli to discuss the issue. Rasmussen subsequently said that Leinders had told him that ‘Rabobank was a team that had “butter on its head”…meaning that all the doping related problems the team had would slide off. And he called me now the most protected rider in the race.”
The former Tour de France King of the Mountains also alleged that in either 2004 or 2005 he was told by Leinders that Zoroli had recommended that Leinders give Rabobank riders the banned substance DHEA because ‘all the other teams are doing it as well.’
Zorzoli was ultimately cleared by the UCI and returned to work in March 2015. He left the post in July of that year.
If an investigation into the Wiggins TUE was to be carried out by WADA, Zorzoli would be a logical interviewee. So too the rider himself, as well as Brailsford.
Jaksche struggles to believe the Sky team principal’s statement in relation to the boosting effects of the injections.
“I found it very funny when Brailsford said that he didn’t know cortisone is performance enhancing. You have to say, ‘okay, then why is the product on the doping list?’
“In that case, I’d like to ask him where he did his MBA. Because I don’t want to go to that university.”
For McGrane, the whole situation is an example of how things need to change. “The TUE system looks like it is a nonsense,” he says.
“Looking at the Wiggins situation, if he had taken a short course of oral steroids, they would have been as effective but not as long acting. It would basically been a more proportional response.
“I think at this point in time, you can’t retrospectively change what happened. You can’t undo a TUE. But what you can do is go back and see if the decision and the approval stands up.
“That doesn’t necessary have to be made public; a good clinical audit is often considered to be something that is done without pointing fingers. But I think that as a learning process and as a way of approving practice and making sure decision making is more consistent and fair and stricter in the future…for a start, having the three person committee meeting is vital. Having one person sign off on this is bonkers.
“You could argue for Froome’s TUEs that he couldn’t have waited for the TUE committee to meet because it was so urgent. But if that was the case, he shouldn’t be competing. He is too sick to compete.
“Really, there is no excuse for the three person committee not meeting. But also that committee – their actions should be reviewed and examined as well. And that should be an ongoing process.”
He’s clear in his belief that the past needs to be studied and changes need to be made. He also believes that Sky has suffered a serious – and likely lasting – knock to its self-declared whiter than white stance.
“That reputation is definitely damaged,” he says. “It is like virginity – you can only lose it once! Once it is gone it is gone…”