Thursday, May 31, 2012

"Retroactive TUEs"

Interesting (and I'm not just talking about Pat Cash commenting on the blog). The ITF just posted an item on applying for retroactive therapeutic use exemptions (TUEs). Earlier this year the ITF posted an item on methylhexaneamine, a few weeks later there was the announcement that Dimitar Kutrovsky tested posted for methylhexaneamine. So, given this posting, the questions are: Who tried to apply for a retroactive TUE? Why? Was it accepted? Did they already test positive?

Here's the release:

Applications for retroactive TUEs are limited to medical emergencies and ‘exceptional circumstances’. Exceptional circumstances are those in which “there was insufficient time or opportunity for an applicant to submit, or a TUE Committee to consider, an application prior to Doping Control.”

According to WADA guidelines for TUEs, exceptional circumstances may include those where a normally healthy player is suddenly affected by a significant medical condition some days prior to an event, and is unable to request a TUE within the allotted time to enable the TUE to be granted.

Thus, players may apply for a TUE retroactively in the event that they need to use a prohibited substance (for valid therapeutic reasons) in order to play in an event. The TUE application form will shortly be updated to reflect this change.


  1. I'm hesitant to think some massive conspiracy is going on regarding doping testing. I just think that to the extent players are doping, they are able to cycle around the testing. Having said that, retroactive TUEs open a whole new can of worms. The reasons given are in the release are legitimate concerns. I can definitely see circumstances where that is a good policy. It does, however, open up the possibility in some situations for a player to say "oh yeah, I forgot to tell you that I was taking (insert medication here)." Much like financial reporting, you need adequate checks and balances to assure the ability to commit wrongs has been mitigated as much as possible. Retroactive TUEs certainly make corruption, or at the very least player dishonesty, more difficult to regulate.

    1. I'm not suggesting conspiracy. But retroactive TUEs, and TUEs in general, are problematic in that, as you suggest, there seems to be plenty of opportunity to abuse the process. All you need to do is find the right doctor.

      I asked the ITF for TUE statistics and they refused to provide me with any.

      However, we see in baseball that there is a rather large amount of players have been granted TUEs for ADD related treatment:

      There's been a lot of speculation that this is an attempt by players to get around bans on stimulants:

      I read somewhere else that, based on the TUE stats, the rate of ADD among baseball players is much higher than the rate in the general population, so it makes you wonder.

      For tennis, WADA does review TUEs, but you have to question whether they have the resources to adequately monitor.

      I would not be surprised if a large number of tennis players have TUEs for ADD related treatment.

    2. I actually have a fundamental problem with TUEs. If the substance can be viewed as performance-enhancing for people without a legitimate therapeutic use, then it can obviously enhance the performance just as greatly for people who actually have a legitimate therapeutic use. If the objective actually were to create a level playing field, the only way to do that is by disallowing TUEs under any circumstance or by allowing ALL competitors to use any substance that could possibly be eligible for a therapeutic use. Such a discussion would open up many questions about how to regulate the amount of each substance that a player could use. It would also raise questions about how to address substances that perhaps regulate body processes that are not present in one athlete, but are in almost all others so as to effectively treat the condition of the "disadvantaged" athlete.

      The bottom line for me is that I would personally rather have sports allow any substance for which they would consider approving a TUE to be used by all competitors, perhaps within certain limits. I'm not really in favor of this approach either, but I think it best puts players on an equal footing. This type of analysis is especially pertinent with respect to the "ADD" cases you point out.

    3. I will chime in here. Doping substances in the majority of cases are drugs with legitimate therapeutic use. EPO for example is a miracle drug for patients suffering anaemia. These are drugs that make sick people well.

      The TUE process is designed to monitor applications for TUE's to ensure they are for legitimate therapeutic use. TUEC's are setup under the WADA Code to review applications. These committees of doctors say yes and often say no to doctor applications for TUE for their patients.

      And WADA have exclusive review of any TUE decision made by a TUEC. WADA can immediately overturn it without appeal. And WADA do do that.

      The emergency TUE (or retroactive TUE) is just that. It is for emergency use only. A normal TUE application process may take 2-4 weeks. In cases where treatment is urgent, the treatment may be given and a retroactive TUE sought.

      Can quack doctors lodge bogus TUE applications. Sure. But most TUEC's I worked with can and do say no to such TUE requests.

    4. Richard,

      I guess my question is more general, regardless of the distinction between retroactive or non-retroactive TUEs. If you assume something like EPO has a legitimate clinicial use and allow a TUE for that, how do you effectively limit such players from using the substance to gain a competitive advantage? Obviously the same question could be asked for substances that are far less extreme than EPO. I suppose you can try to put stringent restrictions on the type of information the doctor must provide and try to control dosing through the TUE, but how do you allow someone to take a substance for a legitimate medical concern and effectively limit their ability to get performance-enhancing aspects from a substance that would otherwise be considered performance-enhancing?

  2. EPO is probably the easiest of substances for which to approve a TUE. One important use of EPO is to treat people enduring anti-cancer treatments like chemo or anti-viral drug treatments for AIDS. These treatments decimate the red blood cell counts and EPO will act to stimulate red blood cell production to return the patient to a health(ier) state.

    The idea of TUE's is to judge when the medical need for a drug outweighs any performance enhancing benefit. And EPO for cancer patients meets that criteria. And indeed the criteria the treating physician must provide in the TUE application are stringent and the more serious the substance as a doping agent, the more the TUEC will critique any application for a TUE.

    1. What about something like the example of Kuznetsova during the exhibition where I believe she was taking ephedrine for a cold. That substance was apparently permissible during out-of-competition periods, but Larry Scott also seemed to imply in his press conference that it would be possible to obtain a TUE during necessary periods for such cold medication.

      If you and I are playing a match at a grand slam, and I have a cold, the implication of Scott's comment is that I could potentially get a TUE for cold medication. While minimizing the impacts of my cold, that medication could also have performance-enhancing impacts on my game. That's why it's banned in the first place. If you're not "lucky" enough to also have a cold before our match, how is it fair that I potentially benefit from a performance-enhancing agent just because I'm sick? I would assume the critique for a TUE involving minor illness would by it's nature have to be much less stringent than something like cancer or AIDS. Common colds come and go quickly and need swift treatment for that treatment to be effective at all.

    2. Kuznetsova was out of competition when the sample was taken by the Belgians. Ephedrine is a stimulant and stimulants are only tested for in-competition. Their use is not banned out of competition.

      Stimulant use OOC is permitted under the WADA Code. This was a monumental screw up by the Belgians. They tested this poor girl for something that wasn't even banned (which was their first screw up) and then breached confidentiality by publicly announcing it (which was their second screw up).

      Kuznetsova could have taken a truck load of ephedrine with a cocaine and amphetamine kicker at that exhibition and not come close to breaking any rule under the then and now WADA Code.

      This ADO thought it had a big fish and wanted to make political mileage out of it. Quote rightly Kuznetsova was cleared as she broke no rule. And the Belgians were shown to be ham-fisted and not understanding of what was in comp or OOC in the sport of tennis.

      So to your question of could a player get a TUE for ephedrine. Highly unlikely. Colds can be treated with a range of non-stimulant based remedies. And treated very effectively. There is no need for a TUE for ephedrine when there are equally good alternatives which are not banned substances.

      I have only seen a single instance where ephedrine was granted a TUE. That athlete had chronic episodes of cold and flu. He couldn't shake it. His treating physician tried all sorts of remedies which would clear up the sinus pain. In the end the doc sought a single treatment TUE for ephedrine in an over the counter cold medication. It was granted and it fixed the athletes sinus condition. And it was only granted because the doctor had tried every other treatment without success.

    3. Thanks. Sorry to induce the diatribe. I'm fully aware of the circumstances surrounding the Kuznetsova instance and why it was screwed up. I just meant to use that as an example for my question.