Saturday, June 20, 2015

CAS 2014_A_3751 X vs WADA

CAS 2014_A_3751 X vs WADA

TAS 2014_A_3751 Athlete X vs WADA

Facts
Athlete X appeals against the reversal of the Therapeutic Use Exemption Committee (TUEC) of the World Anti-Doping Agency (WADA) from the decision of the TUEC of the International Tennis Federation (ITF). The reversal reduced the allowed doses of the hydrocortisone (HC) and withdrew the permission to use Dehydroepiandrosterone (DHEA).

The athlete used medication because of suffering from Hypopituitarism and Adrenal Insufficiency, it improved her daily quality of life and she has had no androgenic side effects. However the WADA regarded the levels of medication as threat to her health and enhancing her sport performance.

Decision
- The appeal is dismissed.
- WADA's reversal of the DHEA TUE is upheld, except to the extent that the Appellant's current existing HC TUE is extended until the Appellant is granted a new TUE by the ITF TUEC, based on a proper medical diagnosis.
- The arbitration costs, to be determined by the CAS Court Office and notified by separate letter to the parties, shall be paid by the athlete.
- Each party shall bear her/its own legal and other costs incurred in relation with the present proceedings.
- All further prayers for relief are hereby dismissed.

29 comments:

  1. Here is the WADA decision / documentation. Based on what I read, I'm really surprised that the TUE was granted in the first place.

    https://wada-main-prod.s3.amazonaws.com/resources/files/cas-2014-a-3751_1.pdf

    The athlete is from a country that requires an (vs a), so American, Austrian, Italian, English etc are possibilities. MDs mentioned in the WADA documentation seem to be American-based.

    The MD whose "diagnosis" supported the initial TUE application (granted in December 2012) is one 'Dr Eric Serrano'.........He describes the athletes adrenal gland as being in "hyper-drive" in one place and under-functioning in another. His medical testimony contains errors, including misspelling of several hormones and significant inconsistencies. WADA questioned his conclusions based on the evidence provided. The documentation confirms he is not an endocrinologist.

    There is a Dr Eric Serrano who is well-known in the athlete nutrition / body building field..
    Info about that person here............http://www.bodybuilding.com/fun/core7.htm
    "World famous nutrition and supplementation expert Dr. Eric Serrano MD. Dr. Serrano is well known amongst elite athletes and coaches who seek his help for the most complicated cases. He also leads the Ohio State University family practice in Columbus, Ohio where he helps people overcome every day problems with unconventional tactics, which produce results!"
    I have no idea if they are one and the same individual.

    After obtaining supportive opinions from MDs who were endocrinologists as part of the appeals process, it appears the athlete continued to use Dr Serrano as her treating MD, which seems odd for such an allegedly complex and specialized medical condition.

    If an individual did genuinely have adrenal insufficiency, than hydrocortisone would be a legitimate therapy. The diagnostic testing for that condition, however, can be inaccurate if the patient is already taking homonal therapy, and WADA contended that this was not clearly evident that the athlete was not already taking HC before initial testing Another key issue is the DHEA, which WADA contend is not standard of care.




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  2. Excellent find. So if WADA blocked them from using steroids, why have they not been punished and, assuming, are allowed to play on as normal? I take it it must be a big name and not some unknown Bulgarian ranked 876th in the world then. The 'an' is also a big give away and the doctor is US-based. Wouldn't be an American player, would it? :)

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  3. The Court of Arbitration in Sport Arbitral Award that I linked to mentions Dr Eric Serrano as the primary treating physician... As I alluded to above, there is an MD with that name, who is well-known in bodybuilding and nutrition circles, and works in Family Practice, as indicated in the report. I do not know if they are one and the same, as I said already. However, it is worth noting that some of Dr Serrano's statements quoted in the document suggest to me that he may not not a native English speaker. The body building Dr Serrano appears to be from Sanjuan PR. Also, He is based just outside of Columbus, Oh, and one of the endocrinologist expert witnesses, with whom the athlete consulted, is based in that city...

    Here is the bodybuilding Dr Serrano talking on youtube about his belief that testosterone is not a risk for heart attacks...........
    https://www.youtube.com/watch?v=m-44nTPAAo4&index=3&list=PLNAUreWTt_SiLQzv8nRze2-_gs4ZtlsIj

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    1. The endocrinologist is from Arizona, like Bethanie Mattek-Sands. Just saying.

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    2. Leave Bethanie alone!

      The poor girl has more than 20 different allergies! Gluten. Avocado. Pineapple, for Christ sake.... It wasn't until she started a special new diet in 2013 that the really improved her results and ranking. She's won 3 doubles slam titles since then.

      You can read about her inspirational story here.
      http://www.si.com/tennis/beyond-baseline/2013/05/09/bethanie-mattek-sands-wta-tour

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    3. I wonder if she swaps stories with Novak about how a new diet can, not just help a little, but utterly reinvent a tennis player's career and ability.

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    4. Dopovich probably can pay better lawyers. I mean, no allegations of "sexism" or anything on the appeal? No allergies to "needles"? Didn't blame it on her mother's faulting genes that she inherited?

      These doping decisions are starting to get boring -- all this science and stuff.

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  4. ^

    And here is bodybuilding/nutrition Dr Serrano talking about experimenting with platelet rich plasma (PRP) on his own daughter, for her spine pain (!)
    https://www.youtube.com/watch?v=OoxrJjsMy1A&index=4&list=PLNAUreWTt_SiLQzv8nRze2-_gs4ZtlsIj

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  5. In CAS documents, they usually refer to the athlete by their full name initially (Mrs Jane A. Doe), and, thereafter, it's either "the Athlete" or "Mrs Doe".....

    If you examine this document, and look at the odd way the name is redacted in different places (running from the end of one line, to the start of the next), I think it's possible to come up with a shrewd guess as to who the athlete's is...... I'm pretty sure I've worked it out, but in case I'm mistaken I'll stop short of mentioning a name............

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    1. https://www.youtube.com/watch?v=WMRUHGnN29s

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    2. For the non tennis savvy ones here could u name the player?

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    3. For the non tennis savvy ones here could u name the player?

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    4. For the non tennis savvy ones here could u name the player?

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  6. When I figured out it was an American female tennis player I was hoping it was the big fish, but it looks like it is some minor minnow who is not even in the top 100.

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  7. It really bothers me that the initial TUE application was approved. The MD wasn't an endocrinologist. There were inconsistencies in his testimony which are well-described in the CAS document. The names of steroid hormones were even misspelled. And the language?

    [quote][S]he displays typical symptoms of a patient with adrenal insufficiency stage three, [b]meaning her adrenal glands are in hyper-drive, or making too much Cortisol[/b] before they burn out. . . [b]The saliva test shows very low levels of Cortisol[/b], indicative of an individual in stage three adrenal insufficiency
    Her blood and saliva test came back as stage III adrenal insufficiency, which included low Pregnelone [sic], DHEA, progesterone, Cortisol, aldosterone, and Dehydrotestosteone [sic] levels, which means she in in total failure.[/quote]

    Stage 3? Perhaps the MD was referring to something called the 'Adrenal Stress index'. I can't find a source about this that that I consider scientifically reliable, but you can read about it here. http://www.livestrong.com/article/206543-adrenal-stress-index-seven-stages-of-fatigue/ Livestrong? What's that?

    I'm not an endocrinologist, but I am a physician, and I can't rationalize the proposed treatment based on the information in the CAS document. I am still baffled as to why a TUE was issued in the first place.

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    1. An explanation can be found here: http://www.mdjunction.com/forums/lyme-disease-support-forums/medicine-treatments/2997768-stage-3-adrenal-fatigueadrenal-exhaustion

      However, the key item reads: "Adrenal Fatigue, as a debilitating condition, is not recognized by conventional medicine and is thus missed by most conventionally trained physicians."

      So, it is not a generally accepted condition, but these more "enlightened" physicians can diagnose it and treat it. As it is not a generally accepted definition, there are a variety of "indexes" in popular use, typically with either 3, 4, or 7 different "stages."

      For a overview of the generally accepted terms, see: https://en.wikipedia.org/wiki/Adrenal_insufficiency (which does not use a "stages" approach, but does break it out based on three different types)

      Curiously, "Secondary adrenal insufficiency is caused by impairment of the pituitary gland or hypothalamus.[8] The most common cause in the United States is exogenous steroid use."

      Also see 2.21 in the opinion noting the diagnosis of "severe secondary adrenal insufficiency."

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  8. I will be curious to see if any of the mainstream tennis media picks up this story. If it is the player who many people seem to suspect, this should be news.

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    1. WADA felt the need to have an ITF-approved TUE for DHEA quashed. The CAS backed them up... IMO, that should be a story in itself.

      Richard Ings tweeted "This is a matter for the tennis investigative journos to dig in to." The problem is that 'investigative tennis journos' are a particularly rare breed! Tennis is not like cycling, where the likes of Walsh, Kimmage, Macur, and Fainaru-wada never let-up when they thought they were telling the truth, even in the face of potential personal hardship.

      I fear the tennis journos will pass on this one because 1] the timing is not right (Wimbledon-season, need for feel-good stories), 2] TUEs, DHEAs and other acromyms are just too technical, and 3] naming names poses challenges (even if it might be possible for some parties to be identified with a strong degree of reliability).

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    2. I think you are right but it doesn't take much work to post a link to the finding. I do see tennis fans as particularly resistant to this kind of news. I am a cycling fan and even Armstrong supporters were always interested in a good debate. Tennis fans just want it to go away.

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  9. Does the ITF publish a list of TUE medicines for which it has given its lame nod? Those are the facts that journalists should now be probing. The ITF could claim the above case was a one off, but two? That would be a pattern. Why is a list of so-called approved substances not published?

    The facts of the matter is that TUEs have become a scam and a means for sports governing bodies to approve, regulate and control doping.

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  10. The % of athletes with TUEs for specific drug classes should indeed be made public. In that case, those numbers could be compared to the expected prevalence rates for associated conditions in similar populations. This would be especially useful for players in the whereabouts program (i.e those of most interest).

    Unless the number is 0 or 100%, medical privacy wouldn't be breached...

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  11. Bethanie Mattek-Sands wins through three round of Wimbledon qualies at Roehampton under the watchful eye of the ITF gazing from its windows, literally! They overlook the courts.

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    1. Do you think for one minute that the ITF is watching Betthany Mattek-Sands like she just robbed a bank.Get real man.How many men and women just passed through 3 qualifying rounds,32.Is the ITF watching them?.This woman did nothing wrong according to the decision.They extended her TUE until she gets proper medical certification then they will give her a new one.What is your problem?Not one person on this site has any proof or knows anyone with proof of illegal doping by any tennis player.All you do is read an article post it and come to your conclusion.Those who can, do, those who can't ,blog.And if you needed a TUE to do your job,you wouldn't say a word.There is only 1 superstar athlete in sports who will continue to dope regardless of the consequences and that is Alex Rodriguez and I am a Yankee fan.

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  12. Meanwhile, the British press are attacking Chris Froom for missing a doping test.......

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