Sir Bradley Wiggins must have been shocked at the turnaround in his fortunes last week. Not long after becoming Britain’s most successful Olympian, he was suddenly ‘fighting to save his reputation’. The controversy, provoked by the hacking of his and other athletes’ medical records, focused on his use of a banned steroid before major competitions. Sounds dodgy, right?
Let’s look at the evidence more closely. The steroid used by Wiggins, triamcinolone, had been approved by the relevant anti-doping bodies. This is because he had applied for a therapeutic use exemption (TUE) — that is, he had applied to use the drug to treat a legitimate medical condition, in his case asthma and a pollen allergy.
For such an application to be accepted it must fulfil these four criteria:
a. The Prohibited Substance or Prohibited Method in question is needed to treat an acute or chronic medical condition, such that the Athlete would experience a significant impairment to health if the Prohibited Substance or Prohibited Method were to be withheld.
b. The Therapeutic Use of the Prohibited Substance or Prohibited Method is highly unlikely to produce any additional enhancement of performance beyond what might be anticipated by a return to the Athlete’s normal state of health following the treatment of the acute or chronic medical condition.
c. There is no reasonable Therapeutic alternative to the Use of the Prohibited Substance or Prohibited Method.
d. The necessity for the Use of the Prohibited Substance or Prohibited Method is not a consequence, wholly or in part, of the prior Use (without a TUE) of a substance or method which was prohibited at the time of such Use.
Even for testosterone, there are rare, very specific medical conditions for which it can be prescribed (specifically, in the case of hypogonadism and subsequent hypoandrogenism). This use is subject to stringent control.
In the case of Wiggins, debate has focused on whether triamcinolone was an appropriate choice of medication, when other less potent medications could have been used, and whether it could have conferred a sporting advantage.
Triamcinolone is a depot, or long-acting, corticosteroid, used for the suppression of allergic and inflammatory conditions in adults. Its point is to suppress an inflammatory or allergic response before it has begun. As it is slower acting, and released more slowly, it could stave off an exacerbation of asthma, in Wiggins’s case, over the duration of the Tour de France. Hence its approval for use before (but not during) major competitions.
As it is a slow-release preparation, the amount of steroid available at any time would be negligible and therefore would likely not confer a significant performance advantage in competition. Over a long time, it is a tiny dose of steroid.
That’s not the impression given by David Millar, a cyclist banned for doping in 2004. He told the Telegraph that triamcinolone was the ‘most potent’ drug he had used in his career and he ‘could not fathom’ how it could be approved. However, for this excitatory, performance-boosting effect, repeated dosing would likely be required throughout a tournament.
The brouhaha over Wiggins and other athletes’ TUEs has been an ill-informed trial by pitchfork-wielding mob. It is outrageous that athletes taking drugs as trivial as salbutamol have been tarnished.
The Fancy Bear hackers who pulled files from the database of the World Anti-Doping Agency (Wada) have clearly had the reaction they hoped for. Whether Russia is behind the team or not, the leaks have served to disguise the chasm between Russian’s state-sponsored doping programme and the legitimate use of drugs to treat medical conditions.
There is a large difference between testosterone enanthate and salbutamol. But to the public, drugs are drugs, and drugs are cheating.
The controversy has also raised the question of whether complete transparency should be required in sport or whether athletes have a right to confidentiality.
Some argue that all applications for TUEs should be made public. For a start, I think most of us would perish at the thought of our own personal medical data being shared for all to see.
It also goes against the nature of competitive sport. Imagine revealing that Wayne Rooney has a knock on the eve of a World Cup final, or that a day prior to a World Championship decider, Lewis Hamilton had a mild bout of gastroenteritis.
Here’s hoping this unnecessary amount of rash judgment will settle down in the coming weeks.