Out of the gray and into the black.
Earlier this year I wrote, “The ‘gray’ zone of what some athletes will do/use to improve performance is a lot wider than most people think.” Well, some seven months later, the width of that zone is now pretty well known thanks to the fanciest bears in all the land. Therapeutic Use Exemptions, or TUEs, are popping up on many an athlete’s record across just about every sport imaginable, especially endurance-focused ones such as cycling and track, and the topic is the talk of the town.
“Cortisone sits at that uncomfortable intersection between recovery and doping to win, situated on the graph somewhere between unethical and not quite illegal,” Suze Clemitson wrote recently in The Guardian. “But the question remains: should a doctor administer drugs to a healthy individual? And does a line exist between helping riders recover from the demands of bike racing (even in the modern era) and using drugs to create a super-athlete who can deal with the rigours of the sport?”
These are important questions, and there are numerous other prescription treatments that can be substituted for “cortisone” and applied to different sports, such as thyroid medications to elite distance runners, which was at the center of last year's Nike Oregon Project investigation. And while some of these prescriptions are for legit medical reasons, how many of them aren’t? Knowing what we know about motivations, behavior patterns and broken systems of control at highest levels of sport, my educated guess is: a lot.
As former professional cyclist and admitted doper David Millar wrote in his excellent New York Times Op-Ed last week, “What was once a doping culture has become an antidoping culture, and the biggest races are today being won by clean riders. And yet there has been an elephant in the room during this period of transition: the T.U.E. culture.”
I believe the same holds true today in track and field (I include road racing in this classification), and that the TUE problem is just as widespread as in cycling. The sports have followed similar trajectories in regard to doping histories and methodologies, performance spikes and drops, and even corrupt governance. Why would TUE abuse be any different?
Interestingly, Lance Armstrong recently had Malcolm Gladwell on his new podcast, The Forward, and they briefly discussed the topic of TUEs, amongst other things. Now, I generally like Gladwell and find many of his takes on the sport interesting and insightful, but his belief that Galen Rupp and the Oregon Project can do no wrong drives me fucking bananas. “That controversy was so bogus,” Gladwell says in regard to last year’s aforementioned investigation. “The stuff they found is also incredibly tame.” Gladwell references Rupp’s TUE for asthma in 2009 but makes no mention of Rupp being a patient of Dr. Jeffrey S. Brown, the controversial doctor who diagnosed him with hypothyroidism, nor does he address the broader claims of thyroid medications being overprescribed to an inordinate amount of other athletes in the sport. The kicker for me was that Gladwell went on to more or less encourage the use of performance-enhancing substances across different domains (e.g. students taking adderall before a big exam even if they didn’t necessarily need it) so that people could function at a higher level than previously possible. He applies the same logic to competition, which is flawed in my opinion. “We’re at a stage now where it’s routine that at the highest levels of performance in many aspects of our society for people to understand that if you’re going to do something, try and perform physically and intellectually at a level that previous generations of people did not, you need help, right?” Gladwell tells Armstrong. “You enlist the best of science to help you through that.”
So what’s the solution to the growing TUE problem in sports? It’s not, as Gladwell seems to suggest, allowing everyone equal access to performance-enhancing substances and letting athletes literally run wild. Quite the opposite in fact. The system needs to be fixed, the gray zone must be shrunk and those who cross its ethical lines should be banned. “A T.U.E. should allow access to a performance-enhancing drug only if that drug is required for proven medical reasons,” Millar writes in his column. “Then a T.U.E. should permit its use—but only out of competition. If any traces of the drug are found by in-competition testing, then that should result in a ban. For an athlete’s own well-being, it is better to face the fact of sickness or injury and withdraw from competition. And for the sport’s well-being, it is better to avoid a system open to abuse and exploitation.”