Monday, April 23, 2012

Stuart Miller Needs To Step Aside: Part IV (Update: Apr. 24)

Update: April 24

Interesting, Steve Tignor read the Stuart Miller interview (linked below) from last week and makes the following comments at Tennis.com:

...It’s not easy to get much out of the ITF on the subject, and Miller sticks to tried and true answers here about how the organization does its work. At one point, though, he claims that all of the tests are unannounced, though most of them are done at tournaments after a player loses. 
Next project for the Top 4: More money for tennis’s underfunded anti-doping program. 
Original Post

See Parts I (here), II (here), and III (here).

Dr. Stuart Miller (2007, ITF World): "...from the ITF’s point of view, having a programme which is free of suspicion, which is transparent and cohesive, is very important."

This represents another interesting statement from Dr. Miller. It is interesting because Dr. Miller's actions are the polar opposite of his words. The statistical information published regarding the ITF's anti-doping program has seen a significant decrease in transparency under his tenure.

In 2006, the year Dr. Miller assumed the helm, the ITF's anti-doping statistics indicated (1) which tournaments had testings and how many tests were conducted at each tournament; and (2) the date on which each player had a sample collected (in- and out-of-competition) and the test type (i.e., blood, urine, and/or EPO). This was useful statistical data.

In 2006, the ITF's anti-doping statistics were very detailed.





By 2011, the details given in 2006 were gone. The ITF no longer states which tournaments conducted doping control. Further, instead of publishing the dates on which players had samples collected (and the type of test conducted), the ITF now just publishes ranges for the number of samples collected from players (i.e., 1-3; 4-6, and 7+). This data is next to useless for analytical purposes.

By 2011, the ITF's anti-doping statistics had been stripped of important details.
This is transparency? When have reductions in transparency been considered to make something "free of suspicion"?

Also, with respect to transparency, we know that the ITF does not publicly announce provisional suspensions unless the player is found by a Tribunal to have committed an anti-doping rule violation. As a result, it appears the ITF has tacitly deemed it acceptable practice for players under provisional suspensions to fabricate injuries to explain their absence from the tour while their case is pending. If the player is exonerated by an anti-doping Tribunal they return to the tour, and the provisional suspension is never announced. To be fair, this particular practice existed prior to Dr. Miller assuming leadership of the ITF's program.

The overall lack of (and reduced) transparency of the ITF's anti-doping program is another signal that it is time for Dr. Miller to step-down as head of the ITF's anti-doping program. He has shown time and time again that he is not up to the job. Someone with a solid knowledge of anti-doping practices (e.g., test distribution planning) and a commitment to enforcement and transparency is needed.

PS: If you haven't already, give a read to Dr. Miller's latest pearls of wisdom and maybe make some suggestions.

39 comments:

  1. Dr Miller is once again taking the slick PR route. Organising what looks like an email 'interview' with the tennisspace website, without any pressing questions or requestioning. Heck, it looks more like one of those infomercial Q&A pieces, where the questions are nothing more than an excuse to rattle off a particular slick, rehearsed answer that someone wants to get out there.

    Sen no Rikyu, you have demonstrated time and time again that:

    a) in-tournament testing is predictable,

    b) OOC testing is very very weak (and skipping tests without repurcussions is too easy),

    c) there is next-to-zero target testing (as Richard Ings tells us, and probably wishes, there *should* be, but there clearly *isn't* in any way), and

    d) the ITF are getting LESS transparent as the years go on. Why? (Think about it... *Why*??!) And being "transparent" is, according to Stuart Miller, "important"!!

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    1. “If you tell a lie big enough and keep repeating it, people will eventually come to believe it. The lie can be maintained only for such time as the State can shield the people from the political, economic and/or military consequences of the lie. It thus becomes vitally important for the State to use all of its powers to repress dissent, for the truth is the mortal enemy of the lie, and thus by extension, the truth is the greatest enemy of the State.” - Josef Goebbels

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  2. As i expected, we now have confirmation that Nadal has continued to get his "PRP" treatments every year (1 to three times a year).

    http://www.deltaworld.org/sport/Rafa-Nadal-continues-obscures-his-knees/


    I VERY strongly suspect that Nadal WILL get another "PRP" treatment after Wimbledon again this year (regardless of the state of his knees).

    Note how the article is very defensive that "PRP is not doping". I wonder why they are so defensive ?

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  3. This is the latest WADA position on PRP:

    Platelet-Derived Preparations
    Platelet-derived preparations (commonly referred as PRP or blood spinning), prohibited in 2010 when administered by intra-muscular route, have been removed from the List for 2011 after consideration of the lack of current evidence concerning the use of these methods for purposes of performance enhancement. Current studies on platelet-derived preparations do not demonstrate a potential for performance enhancement beyond a potential therapeutic effect.

    http://www.wada-ama.org/en/News-Center/Articles/WADA-2011-Prohibited-List-Now-Published/

    PRP is not prohibited under the WADA list

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    1. Blue skies in Richard Ings' world all the time. Richard, do you know who Tony Galea is? Did you also know that a recent doping investigation in Spain (since squashed as all such investigations are in Spain due to insufficient "evidence"), it was noted that athletes were told to fake injuries to their knees in order to get such injections? Did you know that these injections are unsupervised by any doping agency when administered? Did you know that these wildly popular injections, when tested under controlled conditions, are no more effective than a placebo injection of salt water? Would a wise man wonder why there is such popularity of such a useless treatment? Would a wise man also wonder why Tony Galea was smuggling growth hormone into the country in addition to his unlicensed stint giving so-called PRP injections to high level professional athletes? Do you find it interesting that an unlicensed doctor from Canada was in such demand by so many highly paid athletes? Did you know that the last time Nadal got a series of these injections, his serve speed increased by 15 mph and he attributed it to a "grip change"? I appreciate that you apparently want to believe the best in people, but If you can't even maintain basic suspicion, you have no business being involved in the antidoping world. PRP injections are a doping cover. Why don't you do the sports world a favor and begin an investigation into this scam instead of touting the party line all the time?

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    2. Richard, can you give the link to paper study used by WADA to drop the PRP out of doping list? The one that conclude there is no performance enhancement related to PRP?

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    3. Sorry guys but I don't know if there are any papers published on PRP. I just know that the WADA List Committee is about as experienced as they come and if there is evidence of a substance enhancing performance they whack it on the list quick smart.

      PRP was topical when I was at ASADA. Even then the medical advice was that PRP was a therapeutic treatment with no evidence of anything but assisting injuries to heal.

      I think on this one you need to leave it to the medical experts. These sorts of decisions by the WADA List committee are far too technical, scientific and medical. If it enhanced performance it would be on the list with the thousands of other things already on the list.

      There is absolutely no reason why PRP would be excluded from the list by the WADA list committee if there was any evidence at all today that it acted as a doping agency.

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    4. Well, Richard, maybe you should know about papers published about PRP if you are going to cite an opinion about it as some kind of antidoping expert. Maybe you should also know that one of the primary medical "experts" who presented his case to WADA was the doctor who "treats" Rafael Nadal with PRP and who also profits handsomely and sells commercial products related to PRP and no doubt gains extra credibility by being Nadal's doctor. Do you think that is appropriate? The procedure is unproven quackery and there is indeed good evidence that it is used in the context of doping as I have already noted. Someone involved in antidoping should have some skepticism and suspicion, and you don't seem to have any. You take things at face value from so-called experts and you are inclined to believe players when they say things like they thought drug testers were prowlers and had to lock themselves in a safe room rather than get their first out of competition drug test in three years. It is really an astounding level of gullibility that is suited to being a fan of an athlete like Barry Bonds or Lance Armstrong, defending them because there is "no proof," but is not suited to being an antidoping official.

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    5. THASP, your general tone of discourse is a royal pain in the arse. The level of noise it produces drowns the sound of even any valid argument you, now and then, may have to offer. And, strangely enough, it also reminds one of a 'roid-rage-outburst. (The last sentence is no insinuation, just a content-dependent, spontaneous association.) Cheers.

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    6. Wow. OK. I am not a doctor, scientist or other technical expert. I was a manager of 2 anti-doping programs for over 10 years. One for a large international sport (ATP) and the other for a large sporting nation for all its sports (ASADA). I think I know my stuff.

      What goes onto the banned list is determined by WADA and its list committee. They work extensively determining what should or should not go on the list and they decide the new list each September to come into force from 1 January each year).

      In my experience, and this may be inconvenient, the WADA List committee without fear or favour put substances and methods on the list and take them off based on their considerable medical, and scientific judgement.

      Also in my experience, substances and methods tend to be on the list versus cautiously left off the list.

      PRP was on the list. But the WADA list committee have reviewed the treatment and determined that from 2011, for the reasons cited in a previous post, that PRP does not enhance performance but it does treat various injuries.

      Feel free to second guess the WADA List committee. HAve a go at them if you feel PRP should be on the banned list. They won't mind and they will listen. You can even make a scientific submission to them outlining your blind studies supporting your view that PRP is performance enhancing. These decision are made by WADA alone and no sport has the ability to add its own substances to the list. Only WADA.

      As for me, having dealt with the WADA List committee for years, I have full confidence that PRP is not on the list because the evidence that it enhances performance is not there to justify its inclusion. Otherwise the WADA List committee would (indeed it was) put it on the list. They may well do again if new evidence comes to light to support its inclusion.

      I am only purporting to be the level of expert in anti-doping that I am. I have managed big anti-doping programs for 10 years but I am not a scientist but I sure do understand the science.

      I am not gullible at all. My mantra was one of "trust…but verify" and every athlete of suspicion of the sporting world always underwent extensive target testing on my watches.

      I will say again. It is not what you suspect. It is what you can prove.

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    7. THASP. You are dealing with 2 different things. PRP is not a banned method. So any doctor is free to use it. That is a WADA decision.

      But any athlete getting unusual treatments (PRP or many others) is flagged for target testing. That is what anti-doping agencies do. Verify.

      No sport or anti-doping agency supervises this or any treatment an athlete receives anytime or anywhere. They system doesn't work like that, as it is what happens behind closed doors where doping takes place.

      I don't believe the best or indeed believe the worst. The role of an anti-doping agency is to verify. Which is where targeted testing of athletes comes to the fore. Anyone getting these types of treatments should and would be target tested regularly. It is about verifying and gathering proof.

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    8. Melchewhatever, your own tone shows you are not above a bit of ad hominem attack either. Can't handle THASP's points?

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    9. Richard,
      WADA's decision was based on the advice of doctors who not only profit from PRP, but one of these was the doctor who does the PRP injections for Nadal, named Mikel Sanchez. These are not the people that should be making this determination, as they have a vested interest.
      http://www.biobasque.org/aBBW/web/en/news/anitua2.jsp
      Yes, there is no control over the doctors who administer the injections. This is why most such therapies involving injections are looked at with suspicion. Moreover, even if you make the case that PRP is not performance enhancing by itself (I personally think that depends on a few factors), the point is that it is largely a cover for doping. If a panel of doctors claimed that Lasix is not performance enhancing, I would agree. So why is Lasix banned? Because it is used as a masking agent. If you suddenly had a lot of players using Lasix and playing better, stronger and faster, and there were special doctors administering Lasix therapy, some unlicensed, wouldn't you wonder exactly what was going on? And to your point about contacting WADA - I contacted them on many occasions about this specifically. Like you, they tout a party line about it not being performance enhancing if they even bother to return an e-mail. Here's something perhaps you might address. Do you think that the fact that WADA's drug testing for tennis is funded by tennis is an inherent conflict of interest?

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    10. THASP. Here is a link to the WADA List Committee who make the recommendation on what goes on or off the WADA List. That recommendation is then reviewed and approved or not by the WADA Executive Committee.

      http://www.wada-ama.org/en/About-WADA/Governance/Health-Medical--Research-Committee/List-Working-Committee/

      The people you outline don't make this decision. They make a submission (anyone can make a submission) but this WADA List Committee make the decision. They put PRP on the list. But now they feel, and I am not going to second guess them as they are the experts, that PRP should come off the list.

      There is never any control over doctors administering injections. They just need to request a TUE before they treat an athlete with a banned substance.

      Anti-doping agencies test based on intel. If an athlete is being treated by a doctor of suspicion, those athletes should be target tested as no one can look over the docs shoulder to see if he is injecting vitamin B or something banned. So you target test. That is how you verify these types of treatments. Test and look for something on the banned list.

      Furosemide is banned yes because it is a known masking agent. It is a powerful diuretic which assists in expelling banned substances quickly from the body. It has been banned for ages. There are other masking agents as well on the banned list. If you the furosemide, with a TUE (and you would be unlikely to get a TUE for it) then you would get 2 years if it came up in a urine test. Simple as that.

      PRP is not on the banned list as the WADA list committee believe it doesn't enhance performance. It also does not mask the use (in other words make detecting use of a banned substance more difficult) of banned substances according to the WADA List Committee. So doctors are free to use it to treat their athletes.

      But if I was aware of such treatments being used by an athlete, I would target test them just to be sure. What else should one do but target test?

      Every sport funds its own testing. FIFA. ITF, FIBA, UCI, the lot of them all fund their own IF testing. They all manage their own programs, NADO testing is funded by the NADO's government. ASADA is funded by the Australian Government to test Australian athletes. And over all this testing WADA has a transparent view of everything the IF's and NADO's do, and WADA have the power to intervene, appeal, sanction, overturn and generally be a watch dog. And WADA in my experience use these tools where they see the rules not being followed.

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    11. No such target testing is occurring for starters. There is no difference in the testing is occurring. It should never have been allowed in the first place. Even if there was, there is the question of what to target test for and whether such target testing can be done. That depends on what is being "supplemented" with the PRP injections. We know that growth hormone is used. I suspect IGF-1 is also used. That is quite hard to test for and if the athlete came up positive, they can make the excuse that it is just from the growth factors from the PRP. In other words, they can have carte blanche to inject such things along with the platelets. What would really need to occur is an investigation or sting operation. Too expensive you say? Well, it was already done and Tony Galea was caught. Yet PRP is still allowed. Nadal, of course, will go to the French Open, perform spectacularly, winning or runner-up, with no sign of a knee problem. Early in the tournament he will make some reference to his knees and after the tournament he will say that he needs to rest his knees before the Olympics and Wimbledon and get another injection. This is a pattern, so you won't have to say that I'm psychic. When he first got the injections, he got them in his knees. He claimed that he didn't have time to get both knees done before one tournament so got one done before one tournament and one done before another. This is an absurd premise. It takes little time to do this treatment and no extra time to do both at once. No one would wait to have their knee treated until after a tournament because they don't have time. The next year, they allowed intramuscular injections, and lo and behold, Nadal had a "muscle tear" and got the injections intramuscularly. This is obvious suspicious behavior. Anyone with the slightest BS detector would be trying to investigate what is really going on with PRP. The question, in my mind, is what is wrong with WADA and the ITF that they are letting this stuff happen and even enabling it?

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    12. Here is some relevant information about Galea:

      "According to court documents, authorities believe that one of Galea's standard procedures in treating athletes (in addition to his signature platelet-rich plasma therapy, or PRP) has been to add small doses of HGH to the syringes when injecting athletes with a cocktail of other substances. Court documents in Canada suggest that these injections have been such a routine part of Galea's treatment that "it is quite possible that some of the professional athletes are totally unaware of the fact that they were receiving unapproved drugs."

      http://sportsillustrated.cnn.com/vault/article/magazine/MAG1174609/1/index.htm

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    13. THSP,

      WADA allow PRP. It is not banned. Athletes who use it SHOULD be target tested. Such tests test for everything. If a treating physician slips something banned into the PRP treatment, then they roll the dice with testing. There are lots of capability gaps in testing as I have flagged previously. But this applies whether the physician uses PRP alone or PRP slipping in a banned substance. So I don't really understand your point. Testing is what it is. It doesn't catch all doping.

      And I am not up on Nadal's injury treatment regime so I will leave that for you to chase up.

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    14. Richard,

      I think the point being made is that while you have stated that targeted testing should be occuring. The fact is that there is no evidence of targeted testing occurring in tennis for players using PRP treatments (or any players claiming other extraordinary injuries/ailments/training methods/diets/etc.).

      And let's be clear that this is not speculation. The ITF's own publicly available data show:

      (1) The ITF's out of competition testing program is minimal (and weighted towards the end of season);
      (2) Players can (and do) go years without having an out of competition test;
      (3) A missed test is not followed-up immediately (if at all);
      (4) Out of competition blood testing is virtually non-existent.
      (5) In-competition testing is predictable and is almot targeting exclusively losing players at Grand Slam events.

      The only word to describe the ITF's program is broken. And this is why people are asking so many questions and expressing so many doubts. Where is the evidence of oversight?

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    15. re SnR's quote:

      "it is quite possible that some of the professional athletes are totally unaware of the fact that they were receiving unapproved drugs."

      Excuse me while I fall down laughing.

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  4. Verdasco is also having those injections.

    http://www.elmundo.es/elmundodeporte/2012/04/20/tenis/1334921465.html

    There are probably many others who do it but it's hard to find interviews with lower ranked players. I think Tsonga also used it.

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  5. "I appreciate that you apparently want to believe the best in people, but If you can't even maintain basic suspicion, you have no business being involved in the antidoping world."
    Indeed. Suspicion and distrust are one of the most important things in this business.
    I admit that in the long run this type of pessimism can be quite a mental burden.

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  6. Could we get rid of this "you are all a bunch of conspiracy loons" BS for once and for all ?

    We KNOW from other sports (baseball, track, swimming, Nordic skiing, cycling,...) that if there is an illegal advantage that the participants believe that they can use and probably won't get caught, THEY WILL USE IT. The only people that are crazy, are the ones that believe that the ITF won't defend there biggest moneymakers (like Agassi).

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    1. "Could we get rid of this "you are all a bunch of conspiracy loons" BS for once and for all ?"
      No. Why shouldn't we address the obvious?
      You gotta be a conspiracy theorist to post here regularly.
      Just accept it and keep trying to boycott the system.

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    2. To be fair the 'you're just a conspiracy theorist' is taken straight from the Lance Armstrong school of ad hominem.

      If you ever questioned Armstrong's success you were labelled 'bitter, jealous, anti-american, a hater etc etc' Armstrong of course would never miss the chance to wave the 'cancer' flag to try to distract people.

      In some ways I would wear it as a badge of honour and integrity. Love the sport, just hate dopers, those who aid them, and those in the media and administration who cover up for them.

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  7. As far as PRP and Nadal goes :

    We can be almost certain, that Nadal does NOT have acute tendonitis in his knees. Why ?

    - He has claimed that he has had these knee problems for many years. With his style of play, he would be a cripple by now, if he had acute tendonitis.
    - He always returns from his injuries, and performs at 100% (he just crushed the worlds number one at Monte Carlos about two weeks after getting his "painfull knee injections", and he made it to the final in Australia, after having "broken knees", the day before the tournament started). I have never seen this in an athlete before (their injuries, not only have to heal, but they have to get "back in competitive shape").
    - His tendonitis has been magically "cured" by a 5 minute on-court massage. This is not possible, unless he never had an injury in the first place.
    - I have NEVER seen any significant degradation in his on-court speed (remember the FO 2009, where he claimed he was badly injured against Solderling? I watched that match, and he was just as fast as he always is). This is not possible if you have an acute case of tendonitis.
    - I have never even seen him limp. After years of acute tendonitis, and there is no visible clues ? This is not very likely.

    As far as PRP is concerned, it has not only never been proven to work on tendonitis, but most doctors outside of Spain, have given up using it.

    So why does an athlete who doesn't have an injury, go to a doctor who doesn't have a cure for that phantom injury ?

    It is VERY clear that "PRP" is being used as a dodge to administer PEDS (likely IGF1 for strength enhancement).

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    1. I think it has long been understood by everyone that 'blood spinning' is a useful way of masking blood doping. It doesn't enhance your performance but it does enable you to get away with other stuff.

      As we can see from Fuentes, most dopers take a cocktail of PEDs + masking agents. (Which links back to the stuff on TUE abuse).

      I tend to think WADA are often too cautious and slow in banning techniques and substances.

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  8. Mr. Ing, you keep falling back on the party line claim that PRP is not performance enhancing.

    How do you know that the "doctor" is actually administering PRP (direct injections into the tendon) ?

    In fact, the circumstantial evidence suggests that it ISN'T proper PRP injections that these athletes are getting.

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    1. The circumstantial evidence suggests you are a sick person.
      Am I right, Andy Nonomous/Cimber/Your fave dopes/etc.?

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    2. Whatever his name, he must be doing something right 'cause you got upset buddy

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    3. It is not a party line. The decision to not include PRP on the banned list is a WADA decision. I don't have any scientific evidence to the contrary and if I did, the WADA List committee would also have it. The WADA List committee have absolutely no hesitation in adding things to the banned list. In my experience they err on the side of putting things on the list versus leaving them off.

      So no doctor needs a TUE to administer PRP. And of course any doctor could provide an athlete with banned substances or methods whether they are using PRP or not.

      That is why such athletes receiving such treatments should be target tested.

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    4. I agree. Those athletes that use suspicious treatments should be target tested.

      As well, those athletes with suspicious physiologies for a tennis pro, as should athletes with a suspicious doctors (those trained in "doping control", like Dr. Cotorro), as well as those athletes who complain about drug testing, as well as those athletes who support other athletes who have been caught doping, as well as those athletes who are associated with suspicious "fitness coaches" (Gil Reyes), as well as athletes who have a pattern of missing tournaments that have drug testing.

      These things are NOT done in tennis however, yet Mr. Miller claims that the testing is thorough.

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  9. For those who are novices to the PRP debate. Here is one of the few real studies on the therapy: http://bjsm.bmj.com/content/45/2/e1.35.abstract

    By "real", I mean a randomised, double-blind, placebo-controlled trial. This is considered the gold standard for medical studies.

    The study found: "One-year follow-up analysis of the world’s first randomised controlled trial showed no evidence for the use of platelet-rich plasma injection in chronic Achilles tendinopathy." That is, there was no difference between PRP injections and saline injections (placebo group).

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  10. Richard Ings, why did you delete your response to an earlier post of mine in which I said that any close observation of many current players shows that testing clearly isn't working, and you replied that this "absolutely hit the nail on the head"? Gone. You suggested the users are curently way ahead of the testers and the only real hope is that in freezing samples some may be caught when detection may improve in the future. Also gone. Regretting your moment of candour?

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    1. No. I made a typo on my iPhone screen, corrected it, and reposted it.

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    2. So you still stand by your previous comments? (What was the corrected typo and where did you re-post it?)

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  11. I can't find my repost. I have made a number of posts and these threads are getting a bit all over the place. Does anyone else use an iPad to post? I have trouble posting via the browser sometimes as I freezes.

    In any case I stand by whatever my post said. I have said on this blog extensively that testing will only catch a fraction of athletes involved in doping. Testing is easy to beat but freezing samples will keep that evidence for the day when science catches up with the dopers.

    Also testing will not catch the doctor or the coach buying gear for an athlete. Testing is just one tool to fight doping and in my view it is not as important a tool as investigative partnerships with customs etc.

    And I will cite an example. I started with ASADA in 2005. Prior to that date I noted something interesting. In the history of Australian sport no athlete had been found to use EPO. Or hGH. Or even for that matter testosterone. Never ever found in Australian sport. Now common sense tells anyone that to think that not one athlete in a country of 20 million odd has ever taken testosterone, EPO or hGH is probably in the market for Florida swampland.

    Within a short time of developing investigative capability ASADA uncovered numerous doping cases involving all these substances.

    Investigations. Target testing. Freezing samples. Education. All key planks in anti doping.

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  12. Richard Ings, I certainly appreciate the frankness of your admission on this point. I sometimes feel that in the plethora of posts, data and discussion here about tests that rather too much stock is being placed on the possible efficacy of current testing; it assumes that regular testing must inevitably net many of the cheats. (The sport of cycling may be a case in point.) I have no such great optimism while the technology of testing in all likelihood lags substantially behind the sophistication employed in drug use. However the suggestions you make above may at least close the noose a little tighter for the future. (I still support, by the way, THASP's claim that PRP is likely being used to administer ped's, and not just address injury, and WADA has dropped the ball on this one.) Perhaps the single most important step is in educating the wider public to the likelihood of drug use in sports. The demand for action and the resources to support it would therefore increase. Dr Miller and his ilk could not continue to maintain their wifully naive assertions about the lack of drug use in tennis.

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