Russian Hack of WADA Database includes US tennis players: the thin line - use of Therapeutic Use Exemptions

Breaking news:

BBC wrote: The World Anti-Doping Agency (Wada) has condemned Russian hackers for leaking confidential medical files of US Olympic athletes.

Athletes affected include tennis players Venus and Serena Williams and gymnast Simone Biles.

A group calling itself "Fancy Bears" claimed responsibility for the hack of a Wada database.

Wada said in a statement that the cyber attacks were an attempt to undermine the global anti-doping system.

The hackers accessed records detailing "Therapeutic Use Exemptions", which allows the use of banned substances due to athletes' verified medical needs.

http://www.bbc.co.uk/news/world-37352326

This raises a number of issues.  Was the Russian Hack justified?  Are Therapeutic Use Exemptions being overused / used to legitimate doping?  You just need a medical professional to be willing to sign off the claim ... like getting a doctors note to justify a few days off work or school - experience suggests how "flexible" GPs can be.


The BBC are not giving away the details of course and the overall line presented by WADA is that Russians are bad and this hack is not helpful to the fight against doping nor helpful to Russia being accepted back into international sports (they had a partial ban at the Olympics and a total ban at the Paralympics).

One has to go to a Russian sponsored information site to get details:

RT wrote: WADA outraged after hacktivists expose Williams sisters’ use of banned substances .

https://www.rt.com/sport/359215-wada-substances-williams-biles/


The Russian athlete who acted as whistle blower to the Russian state sanctioned doping programme was lauded as a heroine by WADA and the western media.  I suspect these Russian hackers won't be lauded in the same way ...

Lauded for what?

There's nothing in this leak. Simone Biles takes Ritalin and Venus Williams take Cortico-Steroids for her well documented case of Sjogrens Syndrome (probably eye-drops cause the condition reduces the productions of tears)

You may be right but the way the BBC reported it and the way WADA has responded to it has allowed the TUE issue related to them appear to be a serious cause for concern with a suggestion of double standards. From Sharapova's revelations we have already seen how the system has been misused regarding Meldoniun. However in this instance you do seem to be correct.

NS

Sharapova's use of Meldonium wasn't quite the same as these TUE cases, in that she was using a non-restricted substance at least until the end of 2015, after which point it was banned and (if I understood correctly) placed in a category for which TUEs are not permitted. She complied with the letter of the WADA rules, although it's reasonable to question both the ethics of what she was doing and also the good sense - this was not a drug intended for long-term use, and the potential for side effects should not be ignored (if you look at road cycling, which has a long history of doping, the long term health of many riders has been compromised and the life expectancy of a retired pro is not special at all). There are some parallels with the TUE issue, relating to the 'win at all costs' mentality.

There are two issues with TUEs -
1 - Whether they are being used for legitimate medical need or somewhat to 'game' the system. A lot of endurance athletes (cyclists, cross country skiers) have TUEs for asthma medication, but it's very unlikely that many if any have a genuine medical need for them. An example for contrast, where a TUE is essential, the British cyclist Alex Dowsett is a diagnosed haemophiliac and so is permanently on medication for this. Obviously there are a lot of shades of grey between these two situations - for example, I understand the leak shows that Serena has TUEs for a number of different pain killer drugs. For me, it is one thing to use some of these while injured and out of action, but I would have serious reservations about the use of the same during competition.

2 - The issuing of back-dated TUEs to cover non-negative tests.

The hack is not going to give a 'smoking gun' of cheating - if so, it would have been front and centre of this (e.g. a positive for Phelps), but it could and perhaps should open up the debate regarding the use of TUEs.

As an aside, I saw a stat about cycling and TUEs - their use has dropped from a few hundred a couple of seasons ago to something like 15 this year, suggesting that the medical need is frequently quite sketchy.

Good post DH. TUEs are obviously necessary and a lot of athletes will clearly have legitimate reasons for use - Venus with Sjogrens and Biles with ADH being examples. It's obviously unfair that they are now forced to reveal their medical details publicly to defend themselves.

However, there is an underlying issue to be addressed which is the suspicion that many athletes are using them in circumstances where they are not required. That obviously isn't the agenda of the hackers but a public discussion on the point seems to me a positive development.

Serena's painkillers were taken during the period in 2010-2011 where she was out long term, I'm presuming she had a surgery of some sort.

The prednisolone/prednisone she took were all short courses, most during non-competition periods and they're actually legal when taken out of competition even without a TUE.

I agree that there is an issue with the use of TUEs for the wrong reasons, but my issue is this initial leak doesn't seem to show any of that at all, all the of the TUEs seem to be issued for good reason. But as was said, that wasn't the point of the leak, it was essentially to embarrass the USA because most people won't read any deeper than the 'OMG USA FAILED DOPE TEST' headline.

dummy_half wrote:

2 - The issuing of back-dated TUEs to cover non-negative tests.

This - I have read references to it, but nothing concrete. If there is such a thing as a back-dated TUE I'd like to know quite a lot more about it, because it would seem to me to be completely against the basis of the system of strict liability - how can an athlete be entitled to decide to explain the need for taking an otherwise banned drug only after the event under such a system?

TUE are within the rules, so nobody has 'cheated', but I agree with those who consider that they are something of an unexplained grey area.  There needs to be more transparency about who gets TUE's for what, whether they can ever be backdated, whether they are more prevalent in some sports or some countries than other, and whether the numbers of TUE change in response to certain events not related to medical need - even if athletes don't like it.  If transparency is not forthcoming, I suppose the athletes and their sports' governing bodies can put up with the consequences of increased public skepticism, namely less press adoration, less income from spectators, TV, and sponsors, and less state funding.

No, I didn't think so either....

barrystar wrote:

dummy_half wrote:

2 - The issuing of back-dated TUEs to cover non-negative tests.

This - I have read references to it, but nothing concrete. If there is such a thing as a back-dated TUE I'd like to know quite a lot more about it, because it would seem to me to be completely against the basis of the system of strict liability - how can an athlete be entitled to decide to explain the need for taking an otherwise banned drug only after the event under such a system?

TUE are within the rules, so nobody has 'cheated', but I agree with those who consider that they are something of an unexplained grey area.  There needs to be more transparency about who gets TUE's for what, whether they can ever be backdated, whether they are more prevalent in some sports or some countries than other, and whether the numbers of TUE change in response to certain events not related to medical need - even if athletes don't like it.  If transparency is not forthcoming, I suppose the athletes and their sports' governing bodies can put up with the consequences of increased public skepticism, namely less press adoration, less income from spectators, TV, and sponsors, and less state funding.

No, I didn't think so either....

I've now read a bit more about back-dated TUEs, and so will clarify with this further info:
1 - These should not be available for elite level athletes (i.e. those competing internationally or at high national level), who should always obtain a TUE prior to use of any medication for which one would be required. Exceptions in emergency and hospital situation, but that's obvious enough.

2 - These are intended to cover competitors in lower level sports, who are not commonly subject to drug testing but who potentially could be. Indeed, my understanding is that when I was playing rugby at University I was notionally liable for drug testing (and while I would have been clean beyond some passive smoking of dope, I do wonder what would have shown up for some of my erstwhile teammates...). Obviously you can't have everyone in the 30000 field for the Great North Run on UKAD's whereabouts system, but because of the status of the race, theoretically anyone taking part could be drug tested. In this case, the onus is on the competitor to self-declare any medications at the time of giving the sample, and this being used as the basis for back-dating a TUE.

Now of course, this is all good in theory, but I'm sure a few loopholes have been found that have allowed athletes to escape suspension.

djlovesyou wrote:Serena's painkillers were taken during the period in 2010-2011 where she was out long term, I'm presuming she had a surgery of some sort.

The prednisolone/prednisone she took were all short courses, most during non-competition periods and they're actually legal when taken out of competition even without a TUE.

I agree that there is an issue with the use of TUEs for the wrong reasons, but my issue is this initial leak doesn't seem to show any of that at all, all the of the TUEs seem to be issued for good reason. But as was said, that wasn't the point of the leak, it was essentially to embarrass the USA because most people won't read any deeper than the 'OMG USA FAILED DOPE TEST' headline.

I agree with this post. Serena's use of painkillers does seem to correlate to the periods when she was out injured - in any case, and I know it's not just about this, but oxycodone, hydromorphone and what other pain killer she took are certainly not performance enhancing. Oxycodone is roughly twice the strength of morphine whilst hydromorphone is 5-7 times the strength of morphine - ergo they'd make you very drowsy.

The only one that could look slightly dodgy is Biles use of methylphenidate (Ritalin) and dextrosamphetamine (probably as part of Adderall) - both CNS stimulants - presumably prescribed for ADD/ADHD - a diagnosis that's very easy to obtain and impossible to disprove.

I think it's wrong to say that there is nothing in this leak. Whilst the case around the Williams sisters' TUEs seem fairly in order the one for the gymnast doesn't. Ritalin helps with hyper focus which is bound to be a performance enhancer for a gymnast where concentration and focus for long periods is crucial. And this is a drug that can lead to brain defects if taken over long periods of time yet this woman has been taking it for years.

This is why weightlifting should be removed from the Olympics and replaced with tennis' cousin, squash. Basically on retesting stored blood more or less everyone was found to be doping:
http://www.bbc.co.uk/sport/olympics/37371735

Nore Staat wrote:This is why weightlifting should be removed from the Olympics and replaced with tennis' cousin, squash.  Basically on retesting stored blood more or less everyone was found to be doping:
http://www.bbc.co.uk/sport/olympics/37371735

Some irony in the weightlifting story - in one weight class, the guy who finished 9th in London 2012 has now been elevated to the bronze medal position. The irony is that while he didn't produce a positive test (or retest) in London, he is currently serving a doping suspension...

Whilst there is no suggestion that Wiggins or Sky cheated or broke any rules, they have questions to answer about whether they were whiter than white as they claim arising out of the intramuscular injections he had prior to the 2012 TDF; one issue is whether he has been entirely transparent about his TUE's and the Guardian reports that his spokesman has found it necessary to explain that when he said he did not like injections in his autobiography, he meant he doesn't like intravenous injections, not intramuscular injunctions.

Apparently Nadal's records have been leaked in the latest batch - so no doubt that will excite some when whatever are the details emerge.

According to reports, the TUE's relating to Rafa refer to 2009 and 2012. All this is very strange. Can't really see why TUE's are allowed, anyway. As far as tennis is concerned it's a bit like a player saying: "I'm not fit enough to compete unless I take a substance that, for everyone else, is banned."

I think many people that watch sport have never heard of TUE's and so will be confused by all the reporting that says this is a mechanism by which banned substances can be taken "legally".  For me it is a question of regularity of usage, what precisely is being taken, when it is being taken,  what is it being taken for, what precisely is the effect of the drug and what alternatives are out there.  My response also depends on my knowledge of the drug.  So for example I can understand people taking painkillers following surgery and during injury and illness, I am less knowledgeable on the regular use of Ritalin: "produces such effects as increasing or maintaining alertness, combating fatigue, and improving attention", for "attention deficit hyperactivity disorder" and whether or not ADHD is one of those "modern diseases" that has been overhyped to explain behavioural issues.

Ps I know of someone who took Ritalin to improve revision and exam performance and they reported the effort was remarkable: noticeable improvements in focus and concentration. This sort of reminds me of past controversies in the use of beta blockers in professional snooker.

Some people are actually going to come out of this looking cleaner than before since their files are being hacked into and nothing of substance is being found.

That doesn't mean they are innocent of course, but it may look a little bit that way.

sirfredperry wrote:According to reports, the TUE's relating to Rafa refer to 2009 and 2012. All this is very strange. Can't really see why TUE's are allowed, anyway. As far as tennis is concerned it's a bit like a player saying: "I'm not fit enough to compete unless I take a substance that, for everyone else, is banned."
     

Isn't that when they should be? I haven't looked into the dates but he had various issues with his knees and stomach muscle in 2009 and did diddly from French Open onwards. In 2012, he got Rosolled and then didn't play the Olympics or US Open (or any other event) due to further knee issues.

The TUE's have been carefully explained and I do not see any problem with them. If all the rules are followed, then I don't see the issue

Why do "they have questions to answer about whether they were whiter than white". Is it because society wants a guarantee that no-one has ever taken anything no matter how legal?

The public's wish to know that every athlete has never taken anything for anything is naively laughable. Laughable, because using this stance, i.e. absolute zero tolerance, then oxygen tents, high altitude training etc should be banned, because those athletes are getting a higher dose of a performance enhancing product than others

My stance is that I don't think anyone is guilty until found guilty. Suggesting or alluding that Wiggins is now a doubt, because he contradicts himself about injections or getting excited at the forthcoming Rafa revelations - is as shallow as anything The Sun does

Nore Staat wrote: I know of someone who took Ritalin to improve revision and exam performance and they reported the effort was remarkable: noticeable improvements in focus and concentration.  This sort of reminds me of past controversies in the use of beta blockers in professional snooker.

But the beta blockers were eventually banned, i.e. snooker players were punished if they used them after this

I don't get your point. If Ritalin is fine to use under TUE the so be it. It's not as though WADA aren't informed

Mind you, if David Walsh is coming out with naive tosh like this, about team sky ......

“The team that wanted to be seen as whiter than white had been dealing in shades of grey. What they did was legal, but it wasn’t right.”

Walsh is the person who wrote an excellent book about Lance Armstrong called "Seven Deadly Sins" and you'd think would know better

Obviously not "but it wasn't right" is the innocent ramblings of a person discovering their partner's been deceiving them

Born Slippy wrote:

sirfredperry wrote:According to reports, the TUE's relating to Rafa refer to 2009 and 2012. All this is very strange. Can't really see why TUE's are allowed, anyway. As far as tennis is concerned it's a bit like a player saying: "I'm not fit enough to compete unless I take a substance that, for everyone else, is banned."
     

Isn't that when they should be? I haven't looked into the dates but he had various issues with his knees and stomach muscle in 2009 and did diddly from French Open onwards. In 2012, he got Rosolled and then didn't play the Olympics or US Open (or any other event) due to further knee issues.

Good point. Unless of course you're someone who's always been suspicous about Nadal, that is

But why does Wada allow grey areas? All it does is lead to these sort of situations where we are all debating whether anyone has "cheated but it's OK" or "cheated but it's not OK".
Either stuff is banned, or it's allowed.

sirfredperry wrote:But why does Wada allow grey areas? All it does is lead to these sort of situations where we are all debating whether anyone has "cheated but it's OK" or "cheated but it's not OK".
  Either stuff is banned, or it's allowed.

So why is there a maximum alcohol limit, when ruling been over the limit? Why not ban it, i.e. have no limit?

Who's "cheated but it's OK"?

Why was it strange that Nadal had TUE in 2009 and 2012 for his knee injuries? He was out of competition in those times, also was allowed a min dosage. How was that being performance enhancing? More for inflammation and pain relieving than anything else.

Many drugs have short term actions on the body, such as painkillers, and Ritalin.  If they are used in CONJUNCTION with surgery, injury or some other SHORT term medical issue, AND outside of competition, then I can see no reason why such drugs should not be allowed.  

With regards to drugs there are two serious issues a) drug use in competitions.  b) drug use outside of competitions but during heavy training periods: where more intense training can lead to physiological changes to the body (but on the negative side overtraining also makes the body more susceptible to injury).

SFP
The use of medicines under TUEs is not supposed to create a grey area, it is merely there to protect the health of the athlete, hence for example Nadal taking various pain killer drugs during his recovery from surgery. Just because he's a professional tennis player, should his access to these medicines be restricted during times of need?

The issue though, as NS has alluded to, is that TUE's can be grouped into 3 categories:
1 - Absolutely necessary. The most appropriate or best available drug / medicine taken to the correct dosage during a time of medical need

2 - Medically required but opportunistic. Wiggins use of corticosteroid injections for hayfever treatment arguable falls into this group. Yes, he has hayfever but the drug taken, the amount and timing had the potential to offer some performance enhancing benefits above and beyond those required by pure medical need. Other (oral) medications were available, and/or the injections could have been taken further in advance of his major competition goals (Tour de France or Giro d'Italia) without compromising the medical effectiveness.

3 - Playing the system to the extent of cheating. There is something of a scandal in Norwegian cross country skiing at the moment regarding the use of asthma medication by non-asthmatics under TUE approval, and there have been rumours of other athletes being somewhat cavalier with TUE applications.

Generally, the leaked data shows a lot of genuinely required TUEs and a few that arguably fall into the second group but I'm not aware of any that are really evidence of outright cheating.

SFP -A rather extreme example I'm about to give, but if an athlete has a a car accident and needs a heart transplant, should he turn it down because he'd need to undergo steroid therapy and would need a dreaded TUE? Or does he simply have to accept that his career is over because there is no place for grey areas and he "cheated"

K'graf, banbrotam, dummy_half. Very good points which rather knock down my argument. But the whole drugs issue does seem a complete mess. Praps we've reached a stage at which players/athletes or the authorities have to release constant data about what is being taken.

dummy_half wrote:SFP
The use of medicines under TUEs is not supposed to create a grey area, it is merely there to protect the health of the athlete, hence for example Nadal taking various pain killer drugs during his recovery from surgery. Just because he's a professional tennis player, should his access to these medicines be restricted during times of need?

The issue though, as NS has alluded to, is that TUE's can be grouped into 3 categories:
1 - Absolutely necessary. The most appropriate or best available drug / medicine taken to the correct dosage during a time of medical need

2 - Medically required but opportunistic. Wiggins use of corticosteroid injections for hayfever treatment arguable falls into this group. Yes, he has hayfever but the drug taken, the amount and timing had the potential to offer some performance enhancing benefits above and beyond those required by pure medical need. Other (oral) medications were available, and/or the injections could have been taken further in advance of his major competition goals (Tour de France or Giro d'Italia) without compromising the medical effectiveness.

3 - Playing the system to the extent of cheating. There is something of a scandal in Norwegian cross country skiing at the moment regarding the use of asthma medication by non-asthmatics under TUE approval, and there have been rumours of other athletes being somewhat cavalier with TUE applications.

Generally, the leaked data shows a lot of genuinely required TUEs and a few that arguably fall into the second group but I'm not aware of any that are really evidence of outright cheating.

I'd say Simone Biles sneaks into category 3 of your system. A strong performance enhancer for concentration and focus taken from childhood into adulthood when normally only used for children.