In the wake of last week’s report from the UK parliament plenty readers have emailed in to ask for a reaction. Only it’s hard to have much of a response there’s not much new apart from seeing it printed on parliamentary headed paper and getting front page coverage in the UK media rather than back page or cycling-specific coverage. Whatever the British parliament does, the story is set to rumble on and on and it’s been hard to add to past pieces (here and here). Instead a quick look at TUEs where things have already changed but there’s room for improvement.
Some have said TUEs should be banned. It’s a radical policy and makes the issue a lot easier but it also seems to be a means to get rid of the issue rather to explore it. Abandoning TUEs stops people from taking medicine they need, for example diabetics need a TUE because insulin is on WADA’s banned list. So TUEs have their place. Other voices say TUEs should be made public and certainly knowing who is on triamcinolone, aka Kenacort would be informative but sometimes they can be granted to athletes with reproductive issues or bowel troubles and a degree of privacy here surely should be allowed so publishing them is not necessarily easy.
The problem here is not TUEs per se but the use and abuse of corticosteroids. The UCI says it wants to take action here but it’s a signatory to the WADA Code and corticosteroids are allowed under certain conditions. This is partly down to practicalities between distinguishing between therapeutic use and doping, a lab cannot tell if a sample came from a injection or a local cream. This has been exploited for years, in the late 1990s’ one notorious French rider would rub rock salt into his scrotum until it was red and visit a doctor claiming the soreness was down to chafing shorts and asking for some cortisone cream by prescription. Equipped with permission to use cortisone a cheating cyclist could then abuse it by injection and waive their prescription back at the anti-doping testers. The UCI should have followed its own rules and banned Lance Armstrong in 1999 (how would pro cycling have turned out, a thought experiment for another day?).
Traditionally the UCI has been cautious of going beyond the WADA Code for fear of being sued should a wealthy rider fall foul of a cortisone test because it means the UCI would be alone rather than having WADA as a backstop, both in terms of case law and also legal resources including funding. WADA is looking into this but don’t hold your breath. The UCI’s new President campaigned on a pledge to implement a corticosteroid ban for cycling and we’ll see how he approaches this.
One area where things have been tightened up since the Wiggins era is the implementation of a TUE Committee, a panel that oversees granting these. In the past it was often the case that one person alone could approve these and when Chris Froome’s TUE at the Tour de Romandie leaked out WADA ordered the UCI to adhere to its standards which includes having a panel of at least three physicians. The UCI implemented this in the wake of the CIRC Report and now three experts have to unanimously agree. This ought to tighten things up a lot, to have three medics agree that only triamcinolone will do is a hors catégorie hurdle to clear compared to a phone call to the previous UCI doctor Mario Zorzoli.
One solution to the gap between ethics and legality is the MPCC. The Movement for Credible Cycling is a self-regulating, voluntary body where teams sign up to rules above and beyond the UCI and WADA Anti-Doping Code. This is no guarantee but it does bring reassurance because the MPCC tests riders for cortisol levels which narrows the gap between ethics and legality when it comes to corticosteroids. This is good twice over. First it can catch riders up to no good. Second it is a useful health check. To explain, cortisol is hormone produced by the adrenal glands which sit on top of your kidneys. When confronted with a shock these glands produce adrenalin but also cortisol in response to the stress. Low cortisol levels can indicate cortisone doping, approved cortisone use via a Therapeutic Use Exemption or possibly a health problem, perhaps a disease or a concern with the adrenal glands so it’s good to stop racing. A rider with low cortisol levels is at risk, if they crash and suffer injuries, perhaps a blow to the head, the body cannot produce its own anti-inflammation response to a cranial injury. So testing riders ahead of, or during, a race can be a useful idea although the science isn’t settled.
The MPCC “health check” sees riders on member teams tested for their cortisol levels. Like an anti-doping test this is random, there’s little warning and the tests could occur at any race. If the rider were to, say, crash then the body would respond by producing cortisol for the inflammation but a rider with low levels could not and therefore the body’s natural ability to recover is endangered. This is particularly worrying in the case of a head injury where the body cannot produce its own anti-inflammation response to a cranial injury.
Teams can’t be compelled to join the MPCC, that’s the whole point of the voluntary body. However the MPCC has just opened its membership to individual professional cyclists although it’d be awkward to imagine a rider joining because it would only highlight how their team mates and employer won’t although any lone rider joining is to be applauded.
They UCI probably can’t compel them into cortisol level tests either. But the UCI could invite teams or just all riders to take part and a press release issued to say which teams or riders declined to take part and the media could follow up on this. No team would want to start a grand tour with a rider rejecting a health test, the media pressure would be too much.
Similarly if the UCI didn’t want to do this then a race organiser like ASO or RCS could also invite teams to sign up for the cortisol health tests saying they’re free to avoid them but that the test results will be published.
Things are messy but banning TUEs probably doesn’t fix anything and making them public doesn’t seem right because people may have private medical issues. Some things have changed for the better already such as the UCI having a committee process to review and approve applications. Some of this is closing the old stable door after the horse has bolted but it’s good to fix the door all the same.
There’s room to improve. The UCI wants to go further on corticosteroids but it can’t leave the safe harbour of WADA’s Code and WADA keeps reviewing. Some teams have gone further and the MPCC’s cortisol health tests are a good idea, both to reassure the public and to protect rider health. Not all teams want to join the MPCC but the UCI could copy the MPCC’s cortisol tests, inviting teams and riders to take part and publish the results of those who cooperated… and it would be obvious who refused. If the UCI doesn’t want to, perhaps ASO and RCS could instead?