2) WADA’s International Standard for Therapeutic Use Exemptions
The second international standard of relevance to respiratory physicians is International Standard for Therapeutic Use Exemptions (ISTUE) [5], the concept of which was developed by the medical commission of the International Olympic Committee (IOC) that had responsibility for the List from 1968 until WADA assumed it in the 21st century. The policy was initiated during the 1980s when it became evident that some drugs that had recently been prohibited in sport were essential medical treatments and elite athletes like their non-athletic counterparts were prone to experience the same types of medical conditions. At that time, foremost in this dilemma were oral glucocorticoids (GCSs) as a treatment for acute asthma, autoimmune and other conditions. In 2001, this process became known as therapeutic use exemption (TUE). To be granted a TUE the athlete must demonstrate that, on the balance of probabilities, each of the following four criteria is met. 1) The drug is necessary to treat an acute or chronic medical condition and the athlete would experience a significant impairment to health if it were to be withheld. 2) The therapeutic use of the prohibited drug 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. 3) There is no reasonable permitted therapeutic alternative to the use of the prohibited drug. 4) The necessity to use of the prohibited drug is not a consequence of prior use of a prohibited drug or method. In addition to the ISTUE, WADA provides the rules and regulations that apply to TUE Committees (TUEC), the methodology of how a body should grant a TUE and the scope of its mutual recognition by other sports governing bodies and organisations [6]. It stresses the strict confidentiality of the process of TUEs. Further explanations will be provided when discussing specific drugs.
I think you can drive a truck through the regulations. When Chris Froome was caught for many times over the allowable limit they jumped through hoops to not DQ him. Even after they did the dehydration adjustments he was over.
My issue with the way these are applied is that they quote efficacy studies used by the drug companies to get a label. These studies are not designed to measure if the drug works, merely what dose is needed for the ill patient to gain a therapeutic recovery. There are doses considered as having little therapeutic advantage to a sick person, but they have some advantage to a well person. Even if its just maintaining nowmal breathing levels.
When Froome was caught for an illegal level of salbuterol, no one considered that the drug also improved cardiac output by 6% at the lowest dose. From a team that focused on marginal gains, this is huge, but in asthmatics its considered insignificant and irrelevant.
I always assumed you waited for the TUE to be approved before you took a banned substance.
I work in a safety sensitive government job with a lot of medications that would disqualify me. I once was prescribed something and mentioned to a manager I was waiting to take it until I knew if it was approved. The manager looked at me and said, “Son I’m going to tell you something off the record… if a doctor told you to take medicine you take it and if we have to work without you for a while we’ll be fine. The government doesn’t care about you and if you die working they’ll replace you with someone who looks just like you tomorrow.” Granted for me it was more of a having to use sick days situation rather than a suspension situation but I sure hope athletes are looking after their own health first. Because in the end no one else is going to look out for their best interest but them, their doctor and their family. Not a government, sponsor and surely not a bunch of anonymous online posters.
So f-ing wrong--Epo is always banned, can't get an epo tue. Some substances can be used out of competition without a tue, in comp with a tue.
I hate to break it to you, but athletes can get a TUE for EPO. WADA even has a "TUE Physician Guideline" explaining the process for doctors treating athletes with kidney disease or transplants.
I would speculate craig virgin, who had kidney issues was probably on some sort of EPO therapy. EPO is produced by the kidneys and he may have had a deficiency.
