After Assault On ADAMS, Is Transparency Too Opaque On Therapeutic Use Exemptions ?

Editorial

Russians hacking into the Anti-Doping Administration & Management System (ADAMS) of the World Anti-Doping Agency – the place where the confidential profiles of athletes are kept – comes with a loaded agenda, namely, let’s show that Russia and its state-backed doping crisis are somehow the norm not the freak.

Let’s be clear: that’s nonsense. As those behind the hacking and those accused of but denying any role in the hacking surely know, the things we know – not suspect – to have unfolded in Russian sport, track and field at the centre of it all but serious issues spilling into and poisoning the pool and other places, are not the standard model, do not reflect the experience of many other nations and athletes. Russia has a deep and troubling cultural issue that demands a determined and brutal day of weeding.

The same could be said of Chinese doping-related issues; the same, on a different levels with different issues at play, might  also be said of the hypocrisy underpinning a USA team that includes Justin Gatlin and Lilly King, a 19-year-old who said she thought the track sprinter and his two positive doping tests should not be allowed to fly the same flag in the Olympic environment. Legion are the doping issues afflicting world-class sport and yet there can be no question that the Russian story is one apart and one that needs dealing with in determined fashion, both at home and among those at the helm of international governance.

The hackers have sent us the medical records of some of the world’s leading sports names. They include asthma drugs on the banned list but allowed to be taken by some athletes at certain times under Therapeutic Use Exemptions rules. Those rules and exemptions are there for good reason. In extremis, take the athlete who must undergo surgery and requires as part of standard procedure treatments that include substances listed as ‘banned’ in sport. The exemption is granted to the athlete for the appropriate period of time.

For every TUE, there is a case of an athlete seeking, with medical help, alternative treatments that take into account anti-doping rules.  We recall the story of Joanne Jackson, the British international and Olympic bronze medallist over 400m freestyle, who, like many swimmers, took asthma medication during her athletic career. Transparency is at the heart of her story.

Back in 2010, the then 23-year-old from North Yorkshire was diagnosed with a “truly severe and brittle” condition, according to doctors treating her. The particular drug they said was vital to her remaining an elite swimmer was only available in Britain to those who have a record of regular emergency hospital visits and came with two serious issues: a., it was highly expense and therefore restricted to essential cases only in the National Health Service; and b., it was on the banned substances list for elite sportsmen and women.

As a member of the British swimming team, surrounded at Loughborough University by health experts who monitor her daily, Jackson, forbidden from taking steroids under anti-doping rules, did not, of course, need to rely on accident and emergency services to gain access to the treatment she required.

Even so, funding was not guaranteed: the drug in question was a relatively new oral asthma treatment that at the time cost up to £8,000 a year.

 Partly on cost grounds, the drug in question was prescribed in Britain by special permission of a primary care trust only.

Joanne Jackson with her Beijing 2008 bronze in the 400m free – by Patrick B. Kraemer

The drug was recommended by medical experts as a way of getting Jackson back to beat health after her asthma became so bad that she popped ribs out of place through coughing and trying to catch her breath under stress.

A European short-course champion in 2003, a world record holder in the last season of shiny suits in 2009, Jackson was having daily physiotherapy to push those misplaced ribs back into place to keep her in athletic condition.

At the time, she told this reporter: 

”It’s been quite scary because I’ve never been through anything like this before. I’ve had asthma but before Beijing (2008) it wasn’t as severe. I’m not used to it, especially having such serious asthma attacks and then having a panic attack because I don’t know how to handle it. I’ve been seeing Carl (Butler) for physio twice a day some days because of popped ribs, and he’s been great.

“I’m just not used to not being able to finish sessions. That’s the hardest thing: it really hurts when you train like I do with great swimmers and you can see them doing the work. I don’t know how things will go at trials. I have no expectations on myself this year. I’m more focused on getting back to some proper training.”

Jackson’s case was supported by Dr Ian Gordon, the Britain national team doctor, and a recommendation from Dr Neil Martin, the senior expert looking after Jackson at Glenfield Hospital in Leicestershire, England.

Dr Gordon said: “Rapid intervention therapy precluded her visits to hospital, steroids would not be possible.”

Jackson’s condition, complicated by the onset of winter, ‘flu season and persistent sinusitis, ruled her out of the Duel in the Pool against the US and worsened after that.

 “Jo has done something like 30 to 40% of what we wanted her to do in training this winter,” said Kevin Renshaw, her coach at Loughborough University, at the time. “We have had to abandon what we’d planned.”

Sun Yang [Photo by Patrick B. Kraemer]

Such are the choices of many athletes and those working with them: find treatments that work within anti-doping rules or quit sport. In some countries, such as Italy, certain conditions lead to independent medical assessment that may require an …

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