Bradley Wiggins making his way after finishing stage 1
  • JoshLyons

    Once you have tried the corticosteroid prednisolone (Glucocorticoid) you will change your perspective. It removes all fatigue and turns you into superman virtually overnight. I know. When Froome says, “no worries, I’m hoping to peak in the third week of the tour”, as he always does; that’s because prednisolone can be taken for only 7 days and he will begin the dose on the second rest day. If you want the effects of corticosteroid to last longer than 7 days you can become a Wiggins and take Triamcinolone intravenously, which is a synthetic corticosteroid that lasts longer (4 – 6 weeks).

    I’m old and don’t race anymore but back in the day we had this joke about how you turned yourself into a chipmunk by taking corticosteroids (namely “Pred” – or prednisolone) — now just think about who looks like a chipmunk? Hint: Froome.

    Isn’t it a little surprising that all these endurance athletes have bad asthma and allergies. I never saw cycling as a sick persons sport – and on the contrary I believe that cycling keeps me fit, healthy and away from the doctor.

    • Nomad

      There’s a RCT (multi-authored/peer-reviewed) that demonstrated significant endurance benefits with just a short course administration of predinsone.combined woth intense training. Though the study was small based, and with amateur cyclists, I think it shows the potential of performance enhancing effects that some athletes seek via a “legal” TUE route:

      “Short-term glucocorticoid intake combined with intense training on performance and hormonal responses.”

      http://www.ncbi.nlm.nih.gov/pubmed/18048433

    • weiwentg

      It’s not surprising per se that asthma could affect someone’s performance. In fall, I dropped from mid pack to bottom third of the pack at the local cyclocross race when I forgot to take my albuterol inhaler before the race. My symptoms really hit me, and I really started getting treated for them, when I moved to the mid Atlantic region of the US, which is a bit notorious for its spring allergy season. Symptoms persisted after moving back to the Midwest.

      The notion that cycling isn’t a sick person’s sport is probably one of those incorrect assumptions that keeps people from recognizing symptoms and getting properly treated.

      What is surprising is that for Wiggins, proper treatment for allergies/asthma has included injections of a pretty powerful corticosteroid, coincidentally administered before 3 Grand Tours he was competing in for the win. That steroid has potential illicit benefits as well. If he were sick enough to need a corticosteroid injection, then maybe he should not have been racing. Generally you can control your symptoms with the inhalers alone.

      Note the difference there: you seem to believe that cycling keeps you perfectly healthy. I don’t. One can still question the drugs Wiggins was on and admit that chronic conditions can affect your cycling performance in such a way that justifies medical treatment. Even mild asthma, at that level, would almost certainly keep him off the podium.

    • RaggedRobin

      wiggins didn’t take Triamcinolone intravenously

      • JoshLyons

        Okay, intra-muscular. No difference, really. If you don’t still believe me you can ride over to fancybears dot net and look at the original TUE’s from the WADA ADAMS database.

  • Neuron1

    In the interest of full transparency, it would be interesting if Sky released data on every TUE, for every rider, they have applied for and the dates of those applications, as well as the reason for it. Also, since TUEs for corticosteroids are only necessary for “in competition”(if I’m not mistaken), it would be interesting to know which riders have prescriptions and diagnosis for which a corticosteroid is recommended out of competition. If a pattern appears in which riders who are targeting a certain race get a TUE for corticosteroids, or are using them in the out of competition, just prior to that race than there is a problem. For example, if Porte or Landa were to receive these medications just prior to the Giro, it would be very interesting. Also, if key support riders were shown to have the same pattern of use/application, it would show a consistent pattern.

    Corticosteroids alone or in combination with beta 2 agonists such as salbutamol, or any other drugs in this class, will have profound effect on pulmonary function. Since asthmatics have two main components of their disease; bronchospasm and submucosal inflammation there are two main therapeutic avenues. 1) Treat the bronchospasm either prophylactically with beta 2 agonists or after symptoms occur. (By this point in a bike race a rider would have been dropped due to the increased work of breathing) or 2) Treat the baseline inflammation which resides in the submucosal region of the bronchioles, with the use of corticosteroids which can be inhaled or given systemically. If used by the inhaled route there is very minimal systemic effect, but they are very effective on the lung function. However, if you want the systemic “benefits” of corticosteroids you need much larger doses, e.g. intramuscular, intravenous or oral. The combination of systemic anti-inflammatory effect with the added use of a beta 2 agonist, is the ultimate treatment or even prophylaxis for asthma. The systemic benefits to a cyclist are the feeling of enormous energy described as “bouncing off the walls”. This certainly would be helpful as the fatigue of a Grand Tour is wearing everyone else down. (This is a very brief summary of asthma pathophysiology, I deal with and treat this disease on a daily basis in my practice.)

    This data dump reveals something which I have wondered about regarding Team Sky: Why would they have not joined MPCC, it is a PR goldmine. Well here is at least a partial answer. Answers to the questions I posed in the first part of this post would go a long way toward clearing this up by Team Sky. And finally, if the UCI and WADA want to get this asthma question resolved, all athletes who desire to claim asthma should be evaluated by a board of medical/pulmonary experts who are blinded to the name/nationality of the rider and their findings should be final.

    • Robert Dineen

      Hi there, Neuron1, I’m a journalist. Your post is very interesting. Would be prepared to have a quick chat, online or over the phone? My twitter handle is @robertdineen

      • Neuron1

        I would be happy to do so. I am available tomorrow after noon east coast USA time.

    • jules

      Great post

    • dyalander

      I think this points to the more interesting matter here – sky’s credibility is interesting but the real issue is the question of doping/rider health/tues a clearer, more transparent system needs to be explored.

    • Dave

      > And finally, if the UCI and WADA want to get this asthma question resolved, all athletes who desire to claim asthma should be evaluated by a board of medical/pulmonary experts who are blinded to the name/nationality of the rider and their findings should be final.

      I’ve had similar thoughts about making the process more independent, not just about the asthma issue but all TUEs. Transparency is good, but not an end in itself if the process being revealed is deficient and not being improved.

    • Andrés DP

      Great Post! I have maybe a different vision about how to deal with it, it is a bit more radical. I think that the sport has to be something about endurance, training and all this stuff but also about natural selection, if a person needs a TUE to treat X or Y sympthom, perfect! Go home, take rest, treat your disease/disturbance, drink a tea, and come back after that. It is just “extraordinary” how come that most of the pelothon (and who know’s which other sports) is absolutely full of asmathics.

      I’m talking from the absolutely ignorance (given than I’m not a medic or similar), but an asmathic at school/college was almost a synonym of a person who wasn’t capable to resist certain endurance in sports matters.

      • Ride4fun

        At one point 50% of american pro riders had “Asthma” and got various treatments for it including cortisone variants.

        • Neuron1

          You will notice that I differentiated between inhaled corticosteroids which are administered directly to the target organ in very small doses and parenteral systemic medications given in large ones. The effect and “side effect” profile is very different based on the dose and route of administration. You will also note that I don’t argue that many riders don’t have asthma. It is very common in endurance athletes, and is a legitimate diagnosis, as has been shown in the published literature. It is the misuse of the systemic doses, timed to coincide with a race schedule, based on that race schedule and not on true medical indication, that is of concern here.

          • Ride4fun

            Most of the riders with “asthma” were never diagnosed with asthma before turning pro. Incompetent docs not diagnosing asthma? Or non asthmatic riders inhaling legal marginal gains?

    • Geoff

      Based on my personal experience, I don’t really like prednisolone because of the “side effects” it has (apart from clearing up allergies) – I have really only had it prescribed as a last resort to use while the action of inhaled corticosteroids like mometasone furoate comes into effect. That said, I have always found my GP quite willing to give me a script for prednisolone (and usually what I have considered to be a generous quantity). I tend to avoid using it because of its effects on my sleep patterns, although I have to admit while I’ve been on a course, I’ve been pretty lively for someone who is surviving on 4 or 5 hours’ sleep a night.
      I haven’t been formally diagnosed with asthma – my GP took the view that if I can control my condition with salbutamol and corticosteroids without much drama, it is probably not worth it (partly because it isn’t certain that I am actually asthmatic). I am not racing, so I don’t need to worry about TUEs or excuses to take medication, and as it is I can control my condition very cheaply. – Even when not suffering, after a couple of puffs of ventolin I can still feel my lungs open up – it’s a rather nice feeling. I’d still rather be guaranteed a good night’s sleep than go onto a course of prednisolone, however!

    • RaggedRobin

      “if the UCI and WADA want to get this asthma question resolved, all athletes who desire to claim asthma should be evaluated by a board of medical/pulmonary experts who are blinded to the name/nationality of the rider and their findings should be final” –> TUEs already require independent review to be approved

      • Neuron1

        That may be so, however the original diagnosis requiring the medication is not. Therein lies (pun intended) the problem. Any athlete can develop a “medical problem” when necessary.

  • Wily_Quixote

    Is it doping, though?
    Clearly, there is a strong case that Sky is abusing the TUE system in an effort to use prescription pharmaceuticals for performance enhancement, but so long as the TUE system was followed this just appears to be gaming the system.
    Probably time for more robust review of team doctor prescriptions. IV or IM corticosteroids for non life threatening allergies is, when there is a demonstrable performance advantage, not just poor medicine but, at best, very poor adherence to sports ethics for a ‘clean’ team.
    Why did they not make this transparent rather than do the opposite, keep it surreptitious?
    Where was the immunologist review? Where is the respiratory physician advice?
    Where was the adherence to good treatment protocols for allergies and asthma.
    If it can be performance enhancing it always looks to be the prime motivator unless there is sufficient evidence to the contrary.
    This is what the 90s and 2000s has taught us.

    • Rodrigo Diaz

      In my view, it is not doping as the rules establish. Neither were blood transfusions as practiced by the olympic pursuit winning team in 1984.

      Time to make the system more strict regarding TUE.

      • Wily_Quixote

        I agree, I don’t think it is doping unless there has been some kind of corruption in the TUE approval system.

      • Dave

        > In my view, it is not doping as the rules establish.

        Not illegal doping then, but still quite possibly doping according to the spirit of the rules if not the letter.

        I feel that the fact these less effective ‘legal’ doping methods have made their way to the top of the pile might show that cycling is making some progress on doping. For all but the dumbest idiots in the peloton (hi Danilo!) the risks of using the more effective ‘hard’ doping options like EPO have increased at such a rate that they now outweigh the rewards.

        • Bones

          So when a team doctor fraudulently diagnoses a condition and then prescribes a prohibited substance, that’s NOT illegal doping?

          • Dave

            If it’s being done fraudulently, that’s clearly cheating.

            That’s why the unbelievably high number of cyclists suffering from asthma need to be investigated.

          • Exactly. When Wiggins got the TUE for his injection, was he really suffering from severe asthma as he should have been if this was necessary? The question is not whether he went through the proper channels, which he apparently did. It’s whether the channel is not honest about whether it’s a necessary treatment.

        • Dodger

          Dude, they microdose EPO, testosterone …. now. They have ‘doctors’ who advise on how much and when. These ‘doctors’ even test these athletes themselves right before events and if the rider has screwed up and would test positive they make some phony injury excuse to pull them out.

      • Corsa

        Wanna provide some evidence of the winning olympic TP claim.

      • paddyrider

        Team USA did blood dope in 1984 but they lost to Australia in the final.

      • Zucco415

        It’s legalized doping surely. Brailsford promised to be transparent about everything yet would not join MPCC because he wanted to implement a higher standard at SKY which now appears to be BS.
        Surely WADA/UCI was aware of all this hypocrisy. This whole sordid affair has the same taste/smell as the USPS era.

      • Dodger

        Oh, it is doping alright, it’s just legalised doping. Sky is less about marginal gains, more marginal ethics. However in SKY’s defence, they only resorted to this approach to winning GT’s when they realised that nobody wins a GT otherwise. I think they genuinely tried clean at the start. It’s a crying shame that the sport has been so filthy and corrupt at Elite level.

        • Rodrigo Diaz

          It’s definitely dodgy – I don’t mean it is ok, they are just abusing a loophole there. That’s why I mentioned the blood transfusions!

        • Harrison90

          Seems like Froome dog may be clean though, or atleast he’s not abusing TUE’s like wiggins

    • will59

      Your second-last line answers your initial question. The record of unscrupulous doctors doling out diagnoses and prescriptions is long and varied. Sport in general and cycling in particular have no benefit of doubt remaining. The effects of the drugs on performance and the convenient timing of the “treatment” make it clear. Only a head hiding in the sand would not see this for what it is.

    • mick

      Armstrong used a TUE excuse to cover up doping in that infamous incident with Emma O’Reilly. So placing Wiggins in the same light could be fairly straight forward. It’s shows that ‘marginal gains’ are searched for, found and justified (in Sky’s view at least) in any possible way.

      • Wily_Quixote

        armstrong’s was retrospective, so less clear at the time that it wasn’t fraudulent (of course time and confessions have shown it to be both doping and fraud).

        I agree it appears to be a cynical exercise by sky and wiggins to lever the loopholes in the TUE system.

  • dyalander

    I understand the question mark over Sky’s credibility but is it really the most significant question here. The MPCC has repeatedly shown teams love to say they operate to a higher standard until they have to choose between that standard and vying for a race win. That it’s raised and well articulated by Dr Swart is fine but I would have liked a comment on the wider context. Given this issue for Sky and the litany of similar credibility issues around doping/tues/rider health, what specific improvements would he suggest? The reference to Rasmussen, Armstrong etcetera imply he feels there is cheating going on within the TUE system – more on this and what could be done would be interesting.

  • If a TUE for corticosteroid is approved for one rider, then all riders in that race should be granted the same exemption. Seems fair. :)

    • Harrison90

      There should just be a UCI/WADA doctor who has a specific consultation with any rider applying to TUE

  • Craig

    I wonder if imposing a “cap” on TUE’s might help? Kind of like a salary cap, or a “player challenge” to a line-call in tennis. Each team gets a set number of TUE’s each season, to apply for at their discretion. Once used, you get no more . . . and any subsequent health problems for a rider would result in (a) too bad, deal with the illness, or (b) replace that rider before the race starts. You want to form a team full of people who need medication to do their job? Good luck, and choose wisely! No need to ban TUE’s, as some acute health conditions are unavoidable. But let’s at least limit the potential for abuse.

    • Craig

      (Or maybe each TUE should be accompanied by a time penalty. E.g. “Corticosteroid = 30 seconds added on, per dosage.”)

    • zosim

      There’s hardly any TUEs taken out anyway, and certainly in comparison to 7-8 years ago it’s negligable:

      2009: 239
      2010: 97
      2011: 56
      2012: 47
      2013: 30
      2014: 24
      2015: 13

      • Nomad

        Interesting…what was going on in 09? That was also the first year the ABP was implemented…any connections I wonder?

        • Dave

          Zorzoli was using TUE forms to wrap his Christmas presents?

        • Mike

          The status of inhaled salbutamol changed for 2010, because it doesn’t have any effect on anyone who doesn’t have exercise induced asthma.

          • Dave

            I keep on seeing this claim bandied about any time someone questions the 41% rate of asthma sufferers among professional cyclists, quite a reasonable query to raise when cycling is not exactly a great sport for sick people.

            When was the last time this claim was put to the test?

            • Nomad

              The Kindermann meta-analysis published in 07 states that inhaled beta-agonists are non-performance enhancing and have no ergogenic effects (not finding anything more recent). Perhaps it’s more of a placebo effect that non-asthamtic athletes think they’re getting? Here’s the abstract of the study:

              >Sports Med. 2007;37(2):95-102.

              Do inhaled beta(2)-agonists have an ergogenic potential in non-asthmatic competitive athletes?

              Kindermann W1.

              Author information

              Abstract

              The prevalence of asthma is higher in elite athletes than in the general population. The risk of developing asthmatic symptoms is the highest in endurance athletes and swimmers. Asthma seems particularly widespread in winter-sport athletes such as cross-country skiers. Asthmatic athletes commonly use inhaled beta(2)-agonists to prevent and treat asthmatic symptoms. However, beta(2)-agonists are prohibited according to the Prohibited List of the World Anti-Doping Agency. An exception can be made only for the substances formoterol, salbutamol, salmeterol and terbutaline by inhalation, as long as a therapeutic use exemption has been applied for and granted. In this context, the question arises of whether beta(2)-agonists have ergogenic benefits justifying the prohibition of these substances. In 17 of 19 randomised placebo-controlled trials in non-asthmatic competitive athletes, performance-enhancing effects of the inhaled beta(2)-agonists formoterol, salbutamol, salmeterol and terbutaline could not be proved. This is particularly true for endurance performance, anaerobic power and strength performance. In three of four studies, even supratherapeutic doses of salbutamol (800-1200 microg) had no ergogenic effect. In contrast to inhaled beta(2)-agonists, oral administration of salbutamol seems to be able to improve the muscle strength and the endurance performance. There appears to be no justification to prohibit inhaled beta(2)-agonists from the point of view of the ergogenic effects.

              PMID: 17241101

              http://www.ncbi.nlm.nih.gov/pubmed/17241101

      • Dave

        Just out of curiosity, what is the source of these figures?

        Can you clarify whether this is the number of TUEs, or the number of cyclists who received TUEs (potentially more than one per person if they covered shorter periods rather than multiple years)

        • Craig

          It’s from the UCI website, and is the number granted by the UCI each year. Thanks Zosim.

      • Craig

        So really . . . is this showing that there were just 13 TUE’s granted in 2015, across 22 World Tour teams of up to 40 riders each (plus the women’s teams, the Pro Conti teams, etc) for an entire calendar year? It seems much less of an endemic problem (than “Fancy Bears” are making out) when put like that. We’re talking well over a thousand professional athletes across a full facing season, and just 13 TUE’s were granted. Actually seems like a non-event. (Different story in ’09 obviously. Must have been an epidemic that year.)

        • jules

          I prefer to see the glass as half full. clearly there was just a lot more asthma and stuff in 2009

          • Craig

            I’ll check the rainfall totals and solar activity for 2008, see if there’s a link between that and pollen count and TUE’s. ;-)

        • Mike

          You needed a TUE to have an inhaler for Salbutamol in 2009.

          • James Taylor

            I wonder where Froome’s TUE’s are for 2009 and before since he claimed in 2014 (after getting caught out in Romandie) that he has been asthmatic since he was a child?

            Funny how he forgot to mention this very important detail in his book, or anywhere else for that matter, until he was caught cheating in Romandie.

            • Ride4fun

              Also hard to believe that so many doctors and hospitals and testing for Froome’s many “diseases” (typhoid, Schistosomiasis, Hives, Blastocystosis, Asthma) came up negative. Hard to believe labs are so terrible in England and France, but great in Africa, maybe.

              Any time a rider goes from good to great with a medical reason, cancer, resolving 5 diseases, or from a great track rider to a GT winner (there are other examples in the past) I call BS.
              The “Miracle” story is usually the first clue.

              • James Taylor

                Exactly.

              • MD

                Actually the labs in England are quite capable of testing for bilharzia, however, it’s an unlikely disease to check for in this country. As you probably know, the symptoms on bilharzia can seem similar to other far more likely (in England) diseases. Those are of course what doctors would test for. However, doctors who work in Africa in bilharzia regions are far more likely to recognise the symptoms and test for the disease. It’s pretty obvious when you think about it really. (It’s kind of like asking why doctors in sunny parts of Africa don’t immediately think of Vitamin D deficiency caused by lack of sunlight as being a likely source of problems.)

                • ShawnBot

                  Oh please. Real doctors know what risk factors are; know what disease vectors are, and know how to ascertain that a particular patient has spent many years in and made repeated trips to Africa, making some extremely obvious possibilities that much more of a focus of their testing. Thousands upon thousands of people in the UK travel to Africa every year, and given real, actual symptoms that could line up with Schistosomiasis, checking after that fact is going to be within the first five questions asked. Under the circumstances, it is the farthest thing from ‘unlikely’ that Froome would’ve been screened. Had he had any actual symptoms of it. Remember: Never did a Sky doctor find it in him. Even when they knew he claimed to suffer from it. Quite odd, that.

      • Zucco415

        It was something to do with QE to help the economic recovery.

      • Peter

        Of those 13 who had TUEs in 2015, where in the TdF GC did they finish? Places 1-13?

      • Dodger

        Your stats are crap

        • zosim

          Perhaps you could explain that or are you just a poorly disguised troll?

  • Nicolas Thioulouse

    I ve got a very simple view on this. If you’re not fit for racing or sick or need medication to race at this level then you should simply stay home. I personally have zero tolerance for any medical protocol even within legal TUE route- this is not acceptable. Too much happening behind closed doors. French to channel FRANCE 2 has been investigating on a lot of those doctors stil acting in the background and advising rider…aka Docteur “Mabuse” also known as “God” in the peloton

    • Dave

      I agree.

      Corticosteroids should be reclassified as banned at all times (not just in competition usage) and the TUEs permitted only for out of competition use (i.e. recovering properly before returning) with a couple of weeks gap being required between the course of medication finishing and a return to competition.

      This would not be the best way to regulate everything (e.g. not for a TUE for an epipen – in the event of an anaphylactic reaction an epipen is not going to be enough to send you to the podium instead of the hospital) but would be a better template for corticosteroids than the current system.

      The asthma situation needs to be looked at urgently.

  • Steve S

    Just ban the TUEs… seriously, it’s that simple. Elite sport should be a combination of two things – what you’re born with and how well you’ve trained. If you’ve got asthma – and I do myself – well, it’s like being 140kgs and 7ft tall, good on you, but you’re not going to be a top level cyclist. And if someone has a cold / flu / rash on the day of an event then that’s just the same bad luck that we deal with with punctures and headwinds.

    • MD

      Team Novo Nordisk better start looking for janitor jobs then in your new world. The real world is not black and white. Some people will take advantage and try cheat and some people have genuine medical conditions that need treatment so that they can be on the start line with a fair chance.

      • Steve S

        The simple fact is if you have a genuine medical condition you’re probably not meant to win a world class race. Just like if you have a naturally heavy build, personal issues that limited your training, or there’s rain or a headwind on your turn in a TT. Elite sport isn’t “fair”, it’s brutal, but we owe it to the clean competitors to create a level playing field by banning all “unfair” and abusable advantages.

        • MD

          I simply can’t agree with that. I can’t think of a single other sport that bans people from competing simply because they have diabetes or other medical conditions which are treatable with medicine whose performance enhancing effects are controlled by a TUE system. What next? banning people from wearing prescription sunglasses? limiting how much water they can drink, limiting the amount of gels one can use in an event? daft, yet the ideal DNA specimen would be able to get by with less assistance than others who are having their performance externally enhanced over what he naturally has. Yes, what I am saying sounds ridiculous but it’s the end effect of banning anything that’s being used to give you a step up from what abilities your DNA has given you. That’s a clearly foolish direction to take, which therefore requires us to draw a line past – we can legally assist DNA short coming up to a point, but by no more. That line currently does not state that diabetics and people who are prone to asthma in cold air, high altitudes and under immense physical stress aren’t allowed to race, nor that hay fever suffers aren’t allowed to race. If you follow the logic of banning anything that can give an unfair advantage or could be abused, we’ll be back to testing for caffein again (and don’t say there was/should/would be an allowed limit again like there was in the past, because then you’ll be agreeing that using Ventolin in inhaler form is OK because the performance enhancing effect is near zero and it’s near impossible to accidentally “overdose” and reach banning levels, but it’s never the less not zero).

          There is one more extremely important thing to consider. Elite sport has the same rules as all other levels of that sport. The local 10mile/16km TT around here could, in theory, also be drug tested. That means that the local 50 year old 140kg guy you described, the one who took up cycling to get fit and loose weight, who takes 40minutes to complete the course even on a good day, is not allowed to take PEDs either. And by your proposed rules, he can’t take any medicine that at present would require a TUE, nor even be a diabetic, and certainly forget being asthmatic. That puts the vast majority of athletes (99% of athletes are not elites) at health risk (they can’t take medicine their doctor would prescribe to keep them healthy) or excludes them from the sport. Alternatively you are suggesting a tiered system of rules where the rules change between elite and the other levels. Yet of course, a rider can only achieve elite status by working up through the system – to suddenly exclude someone is unfair, just as it would then also be unfair (if you believe any TUE treatment to be illegal) that they’d already excluded other’s from winning their way through the lower ranks as well. The system can only work if applied through all levels as it’s done now. And that requires the rules to be fair and realistic across the board – banning all TUEs is clearly not fair because it in effect bans all people with any medical condition from any level of participation in the sport.

          I suspect I share your frustration and disappointment that there are some people who may be cheating the system at the top level. However, a ban on TUEs is not the way to go.

          • Steve S

            You ban all TUEs and you have as close as we can get to a level playing field. It’s not perfect, there are plenty of sports that a lot of kids don’t get the opportunity to compete in (and this removes far more people from the field than illness), but the fact is those who are there are judged on the same criteria.

            Once you allow TUE’s – which are exemptions for Performance Enhancing Drugs after all, the level playing field is gone and we all know there is no shortage of people willing to abuse it. I actually know someone who sets the drug testing strategy / policy for a major sporting country (top 10 in this year’s Olympic medal table) and he’s adamant that the type of person who can get to world class level has a personality type that will do *anything* to get an advantage. He’s scarily matter of fact about this, he sees it all the time.

            Now on one hand it’s unfair that people born with an illness wouldn’t be able to get to the top, but that’s just the same as a potentially amazing boxer born with a short reach, an awesome driver who can’t fit in a Formula One cockpit, or a great sprinter with a different leg length than the rest of the field. Unlucky, unfair, but that’s life. You can’t claim to be the best in the world when you’re taking a PED, and any use of TUEs/PEDs just adds to the cynicism we all feel.

            I take your point about Elite sport having the same rules as other levels and to me that’s where the problem is. I don’t mind who I compete against, but world #1 has to be what you’re born with and how well you have trained. Do you honestly think any of the high profile cyclists / tennis players etc caught using TUEs recently (or thinking they had TUEs) genuinely needed them?

  • James Taylor

    Let me offer a different perspective to a couple of points contained within this ‘Froome fanboy’ Jeroen interview.

    Firstly corticosteriods do not change you from a donkey to a gt winner as Wiggins and especially Froome have done (in Froome’s case over a four to six week period). Taking these and other grey area medications might take them to the top 50 of a gt possibly but certainly not top ten. This is simply the tip of the iceberg to what they are actually using. Corticoids are just a small part of a much bigger cocktail of peds taken by gt contenders. Microdosing epo is pretty much standard and also undetectable (as Mark Daly kindly proved last year for the BBC). This is especially true when you use the best method of tricking the biopassport repeatedly, namely the old classic ‘altitude camp’ which then allows a much greater variation in passport values. Basically, these guys are doing a lot more than corticosteriods.

    Secondly I completely disagree with fanboy Swart that Froome comes out of this looking good for a couple of reasons. The first of which is that Wiggin’s TUEs are more obvious because he was within the SKY system and actually competitive when most of those TUE’s were prescribed, whereas on the other side Froome was getting disqualified from GT’s for cheating (Giro 09) or pushing better riders uphill (Greg Henderson), or about to be palmed off to any team that would have a pro conti domestique (August 2011). Froome’s two TUE’s certainly did not hinder him winning the two races he took them for, and the second one was clearly cheating (backdated by a single, later banned doctor, just like Armstrong). Froome was a complete donkey before his ‘miracle’ (and it is a miracle never seen before if clean) transformation from the lowest rated member of SKY according to Dave Brailsford’s chart of potential, to the so called greatest GT rider of the modern era. His one big asset is that he could cheat away from the SKY umbrella with the psycho Cound simply because nobody gave a shit about him. Basically they are both dirty as hell and everybody already knows this, apart from the fanboys of course. Hopefully this will slightly open their eyes to what a dirty sport cycling is and GT’s cannot be won clean, not a chance.

    I have a question for fanboy Swart ‘how does a rider who is already mature as a rider (and please spare me the Kenyan backwater bullshit, that one has been thoroughly debunked) and a nobody/never will be, transform (and it is a transformation) into a gt destroyer? Someone who can ride like the classic epo style rider, someone who apparently can lose loads of weight and yet increase his flat power massively. Bear in mind that at the time Froome did not use the bullshit bilharzia excuse, rather he said that he had stopped wasting energy attacking all the time. Except that there are no instances of him ‘attacking too much and wasting energy’. Go and look at his previous races, when was he attacking all the time. This then changed to the well known bilharzia obfuscation, where his timeline changed continuously in interviews. Then finally the Esquire fanboy classic ‘he just lost the fat’. If Froome has nothing to hide as he claims, then release all power, and biopassport data from 2011. Simple.

    Finally how is it that if Wiggins is so dirty (which he clearly is) and was so competitive at the top end of GT’s with other famous dopers, that Froome could beat them all clean and easily? It just doesn’t work at all.

    Unfortunately Jeroen you yourself have played a big part recently in Froome and SKY claiming complete transparency and the classic ‘what more can we do to be credible?’

    I think stop doping would be a good beginning.

    • Nomad

      I think you bring up some good points. The PEDs from the 70s, 80s (e.g., amphetamines, steriods, T & even corticosteroids) had a minimal effect on endurance performance. From the research I’ve seen, maybe 1 or 2% on increases in VO2max, LT, time to exhaustion, etc. They pale in comparison to the huge performance gains, particulary with climbing speeds, seen with O2-vector doping. Both LeMond & Fignon had said they’ve never seen anything like it when EPO was introduced in the peloton in the early 90s. And when the EPO test was implemented in 2000, riders just switched to old-fashion blood doping & microdosing EPO.

      Presently, autologous blood transfusions are impossible to detect as long as the athlete maintains blood values within the upper & lower parameters of their ABP. Experts also tell us that microdosing EPO can be used as a masking agent to boost retics when transfusing. And Bernhard Kohl enlightened us on how easily he transfused during the Tour (20 mins!):

      http://www.cyclingnews.com/news/kohl-tells-all-about-doping-1/

      And now you have a new form of O2-vector doping with HIFs (e.g., FG4592), that don’t appear to alter the ABP:

      “Detection by LC-MS/MS of HIF stabilizer FG-4592 used as a new doping agent: Investigation on a positive case” (J Pharm Biomed Anal/2016):

      http://www.ncbi.nlm.nih.gov/pubmed/18048433

      • James Taylor

        Thanks for the links Nomad, I’ll take a look a those. Great post btw.

    • Zucco415

      The real sad thing is that the sport of procycling has been hijacked by a bunch of wankers, and until the purge them out not much will change.
      The dirty riders are the “pawns” but complicit nonetheless.

    • RaggedRobin

      I am also baffled at how the media is giving Froome a pass when his use of prednisolone is much more questionable on top of the fact that Wiggins was NEVER dominant in competition outside of TT stages. He was always JUST good enough to hang on in the mountains, concede a few seconds, then seal it in the TT. Froome blows everyone out of the water in the high mountains, TT, anywhere..

  • Eden Walker
  • David Simons

    Very well written article, it addresses the issue directly. One thing I get from it is that the ICU forbids doping, yet they are highly complicit in legalising forms of doping. Jeez, I’m even starting to feel sorry for Armstrong now…

  • dsd74

    To start, I’ll be clear that I’m not trying to make excuses for riders who seem to be pushing the envelope with TUEs. But could the unstable finances of cycling and short rider contracts make it a hard choice when deciding on whether to take time off racing when sick? How many commenters here on contract jobs are able to tell a client that they’ll have to wait a week longer to get the product, report, whatever because you’re sick, and risk having the client go somewhere else next time? Taking time I racing can mean missed results or a teammate taking your place in the future for big races. Again I’m not pro-TUE just putting it in perspective.
    Somewhat related: a new colleague of mine was an assistant professor while finishing his Ph.D., he constantly had to deal with students asking for extensions for papers and exams; yes some people got doctors notes stating that they need and extra two hours to complete the exam or an extra week due to some medical conditions! In fact in one class of 20, they needed four different exam rooms as some students had doctors’ notes claiming they needed extra time, or natural light, of had to be at least three meters away from the nearest student… All that to say is that some students who ended up with top marks got bursaries, who according to him didn’t deserve them ( the proof is that when it came to time in the lab, they were clueless).
    Sounds like TUE issue in cycling, no?

    • Mike

      Speaking as someone who enjoys riding his bike but is ambivalent about cycling sports I am amazed at the number of experts on doping who inhabit internet forums. Who knew all this knowledge, experience and considered opinion was freely available at the click of a finger?

      • Mike

        Sorry dsd74, my comment was not intended to be a reply to your perfectly sensible tale. Obviously I know as much about forum posting as some others know about drugs.

        • dsd74

          Don’t worry, I wasn’t offended! But I’m also as intrigued as you are about how people become experts on every subject when seated behind a screen in the comfort of their homes.

          • David9482

            haha, funny comment, but of course cycling fans have learned more about doping than their counterparts in other sports. The stories of how cyclists would evade testers have been common knowledge amongst cycling fans for years.

            It isn’t a conspiracy or anything, and it isn’t really noteworthy. If you’re not interested in doping related discussion, which is understandable, then you’d of course be surprised or shocked or whatever at these comments. But many of us read and learned how our cycling hero’s were cheating to win, so naturally we’d research to figure out what they did…

      • James Taylor

        Not you clearly.

  • James_Casper

    TUE is a form of cheating. I wouldn’t call it a form of doping though.

    It’s cheating, just like getting food in the last kms of a mountain stage.

    It’s cheating, just like Pat Rafter used to do when taking a medical time out for cramp. Serious.

    It’s cheating, just like flying your plane at low altitude back from a football match to aid recovery.

    It’s cheating, just like hooking yourself up to a IV drip at 1/2 time of a footy match.

    It’s cheating, just like throwing your cricket balls into the ‘square’ whilst fielding to roughen it up.

    It’s cheating, just like smacking sunscream on your forehead then rubbing a half of the ball against it to aid in swing.

    It’s just not against the law/it’s getting pretty close though. It’s professional sport – EVERYONE will push the margins as far as they can to win.

    Sport is stuffed. Full stop.

    Don’t like what SKY is doing? Don’t watch cycling. Nothing’s going to change.

    • Neil

      With all the keyboard warriors coming out, claiming to be experts on PED’s and the nature of sport, it’s nice to see someone look at the broader context.
      IMO, way too much time spent stressing about this. Far more important things in the world to worry about. Just ride your bike.

      • James_Casper

        100% spot on.

        Love riding my bike. There’s nothing any pro rider / pro team could do, that could ever, ever diminish my joy.

      • James Taylor

        ignorance is bliss… for the ignorant. Loving all the people trying to shoot the messenger and those people who have actually done some research, instead of claiming they are above all that. What kind of keyboard warrior comes here come here to tell people they are above it all. If you were above it all you wouldn’t be writing here. What a strange kind of gullible some people are.

        • Neil

          Care to explain why I am gullible? Or where I’ve claimed that I am somehow morally superior to others? Or how any part of my statement indicates my ignorance?
          Elite sport is stuffed, as stated in the original comment. It is in its nature that at the elite level, everyone will seek every possible advantage or marginal gain. This doesn’t make it right, but it is what it is.
          If you really want to spend every waking moment of your life stressing yourself over whether someone won a bike race through morally acceptable means, go for it.

        • Neil

          Also, perhaps I’m wrong, but I’m not sure that experts in TUE’s and sports doping hang out waiting to comment on news articles.

      • Dodger

        It’s hard for parents to support kids and their sporting dreams when they are talented knowing this is what is in store when they try to see how good they can be at cycling, athletics and just about any other sport. People with your attitude are a big part of the reason these problems can exist.

        • Neil

          I respectfully disagree. I support my kids participation in sport to develop fitness, healthy lifestyle habits, teamwork, resilience and simply have fun. The chances of becoming a professional athlete in any field are tiny. If you want to talk about problems in cycling, I think the much bigger problem is people involved in the sport who have records of human rights abuses or corruption, like the new Bahraini team, rather than questionable TUE’s. By all means, I’d love to see any sport free of doping, but I feel this issue isn’t viewed in proportion to other massive issues.
          Would you be okay with your child riding for a dictator who killed and tortured to remain in power? Or would this be okay if they had signed up to the MPCC?
          People with your attitude are a big part of the reason these problems can exist.

          • Dodger

            ? I think I just broke the rule – never argue with an idiot because they will bring you down to their level then beat you on experience. Tip – if you don’t like reading opinions of people who care more about the sport than you do, do us all a favour and stay away.

            • Neil

              Nice. Interesting comment for someone who has berated everyone with a different viewpoint to you and has only commented on this topic.
              I’m out.

        • Neil

          I respectfully disagree. I support my kids participation in sport to develop fitness, healthy lifestyle habits, teamwork, resilience and simply have fun. The chances of becoming a professional athlete in any field are tiny. If you want to talk about problems in cycling, I think the much bigger problem is people involved in the sport who have records of human rights abuses or corruption, like the new Bahraini team, rather than questionable TUE’s. By all means, I’d love to see any sport free of doping, but I feel this issue isn’t viewed in proportion to other massive issues.
          Would you be okay with your child riding for a dictator who killed and tortured to remain in power? Or would this be okay if they had signed up to the MPCC?
          People with your attitude are a big part of the reason these problems can exist.

    • dsd74

      “It’s professional sport – EVERYONE will push the margins as far as they can to win”

      Substitute “sport” with almost any other profession, and the same applies. I think everyone has pushed the envelope and done things that are legal, yet perhaps against the spirit of the law/rule. Anyone claiming otherwise better have a good helmet for when they eventually fall off their high horse!

      • Wily_Quixote

        It’s not ‘pushing the envelope’ it is defrauding other professional athletes.

        So it is much more like white collar crime than just being against the spirit of the law.

        • Dodger

          Exactly. These creeps steal the dreams and livelihoods of the more honest and deserving. Who wants to encourage that on society? Well, maybe Neal and his ilk that don’t care.

  • Douglas Ferguson

    I feel like the fact that these TUEs have been fully approved by the necessary governing bodies is being entirely overlooked? Somebody in authority has concluded that the injections are a medical requirement which means that on paper, none of the athletes have done anything wrong whatsoever.

    • Dave

      It hasn’t been overlooked, it just simply isn’t on topic.

      The whole debate is around whether the process leading up to that approval is fit for purpose, or if it needs to be reformed.

  • Rupert the Super Bear

    You don’t think perhaps that you lot may be ever so slightly lost in a world of your own cynicism? A little too well informed perhaps? With the amount of info you guys have to hand, I’m surprised you follow the sport at all.

    I’d wager the majority of posters are American – right? Won’t be fooled again perhaps?

    • Mike

      You may have a point here Rupe, I get the feeling that this allegedly Australian site is slowly morphing into just another US clone. Not that there’s too much wrong with American sites, I use a couple regularly, but it was nice to get the antipodean perspective on all sorts of issues.

    • David9482

      Haha, naw, you’re wrong, it’s not a US clone site. Look at the timestamps of when people usually post comments. The majority post during the land down under’s workday, not North Americas.

      • Rupert the Super Bear

        But you are an American right?

        • David9482

          HAHA. No, not American.

  • david__g

    Interesting about Kenalog. I have to have it injected into these god-awful cysts I get on my face (bet this ruins your impression of me as a handsome b*stard, right?) but never knew it had other, more dubious uses.

    Also, why don’t I go faster?

    • RaggedRobin

      read Tom Cary’s article, triamcinolone alone isn’t performance enhancing and Millar’s comments fail to mention that he was hopped up on EPO and testosterone at the same time he was on triamcinolone

  • Gooner

    I see a load of idiots commenting on something they know nothing about, spouting their libellous drivel. Team Sky should sue each any every one of the cowards trying to discredit the team, on here. Because, that is what you are! you know nothing!! Gullible little children, who think they know something, when they don’t. Team Sky have done nothing wrong. It is the cowards and liars commenting on here, that have!!

    • Wily_Quixote

      You left off some exclamation marks, I think.

      • Gooner

        I am not interested in bullies like you. Or a site, that promotes bullying, and gives no reason for blocking people. This site is a fraud.

        • Wily_Quixote

          I agree. As soon as I find a way to block myself I will be satisfied.

          I have recommended that CyclingTips use a less aggressive font as well, but my suggestions were not heeded.

          I recommend that you spend some time away from the site to create a safe space for yourself. No one should be subject to such a site that promotes free-thinking and free-speech. It is un-american, or un-austrayan, or something.

    • Dodger

      Hold the roid rage

      • Dave

        It should subside once his TUE expires.

    • Dave

      > Team Sky should sue …

      For what?

  • mt

    Lung function testing is quick, effective and reliable- via spirometry. There is a clear distinctive ‘cut-off’ result to qualify as ” asthmatic”. It would diagnose true asthmatics, is easily done and is reliable… you can’t cheat the test and you get a clear diagnosis.. I suspect there are cyclists who are asthmatic and aren’t aware they are, and conversely, a few that might think they are but are not.

    • MD

      It’s my understanding that the process of getting a TUE of an asthma drug does require testing and results to be submitted. I don’t know this first hand, but I do recall reading that there was a process that had to be followed – it’s not simply a matter of getting a team doctor to write a script for a drug and filling in a TUE form. Other forms of drugs may well be different. Perhaps part of a solution would be that the UCI or WADA embeds a doctor within each team and only that doctor is allowed to apply for TUEs. And the doctors are rotated yearly to new teams. Teams could still use their own doctors for normal treatment (we all know that a long term relationship with a doctor works best in terms of monitoring health over time) but the daily involvement of the embedded doctor would allow a better oversight of the development of conditions that might end up requiring a TUE. At present, the first time an impartial medical person gets involved is when the TUE application is submitted. That doesn’t give the UCI doctor the same context as what an embedded doctor would have. My proposal isn’t “the solution” but I think it would be a step in the right direction.

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