How to make sports fair? Eliminate the TUE, says Dr. Paul Dimeo

Dr. Paul Dimeo is familiar with doping controversies.

Dimeo, a senior lecturer at the University of Stirling, has spent the better part of the last 12 years studying drugs in sport and writing various articles and research papers on the ethics governing the anti-doping movement. This April, Dimeo and his writing partner Verner Moller will publish a book about the anti-doping movement, titled “The Anti-Doping Crisis in Sport: Causes, Consequences, Solutions.” The book examines several areas of the modern anti-doping movement that, in Dimeo’s eyes, cause inadvertent consequences and direct problems for athletes, governing bodies, and fans.

One such area involves the Therapeutic Use Exemption (TUE), the WADA-approved document that allows athletes to take a banned substance for medical purposes. In recent years, the TUE has become a polarizing tool within the anti-doping arsenal. In the United States, some amateur athletes can now earn a TUE for prescription testosterone. In 2016 the Fancy Bears hack of WADA revealed that Olympic champion Bradley Wiggins had TUEs for powerful corticosteroids in the lead-up to his 2012 Tour de France victory.

In an op-ed last month, Dimeo wrote that anti-doping agencies should consider eliminating the TUE altogether if fair and consistent rules are truly desired. We caught up with Dr. Dimeo to discuss the pros and cons of eliminating the TUE.

VeloNews: In your opinion, what is wrong with the current TUE system?

Dr. Paul Dimeo: I think the TUE system offers an opportunity for people to use drugs that they wouldn’t otherwise be allowed to use. It’s a simple summary. What we saw from the Fancy Bears hack was there were some TUEs given that didn’t have any doctor’s signature, or maybe just one doctor’s signature. So it might not be that difficult for a doctor to make a mistake, or just do a repeat prescription for something that the athlete had showed earlier symptoms for. Or, quite simply, for the doctor to feel bribed or under pressure or just compelled to help the athlete.

Then there is the matter of the health of the athlete. The whole thing opens up the idea that medicines are not just for the health of the athlete, but they are there to get the athlete back onto the field of play. That actually allows them to play with an injury, if this substance or medicine may be given in a normal medical situation. So you could be giving an athlete a long-term risk of health by allowing them to compete with [a TUE]. I think that is extremely questionable.

The arguments against my point are that people should be allowed to use drugs, at certain times. If that’s true, then people are going to abuse the system. I’m just putting the logical model on the table.

VN: In your piece, you write about the inconsistencies with the TUE rule. Could you expand on that?

PD: There’s also a lack of consistency and fairness in the system. Let’s say athlete No. 1 has asthma 0r a pollen allergy or muscle pain, or something else that can be relieved by some medication in the short term. Athlete No. 2 has a broken leg. So why does athlete No. 2 have no recourse to some type of medicine to get them back on the field, where athlete No. 1 does? Athlete No. 1 can participate, while Athlete No. 2 cannot. That seems to me to be very arbitrary. The underlying message is that Athlete No. 2 is simply unlucky because there is no medicine to unbreak their leg and put them back on their feet.

It’s philosophical point I’m trying to make, rather than a policy point. There are of course athletes who have natural deficiencies for whatever reason. On an individual level, I tend to say there must be a bit of a give and take, and a way to give them permission to come back into the sport. If someone was sitting across the table from me saying, ‘It’s not my fault, I have this problem,’ I would concede. Still, I cannot think of a policy or system that gets over the problems that are facing the TUE process.

VN: I can understand the philosophical points around having natural limitations of performance. For example, if you have an injury or illness, that is simply a sign that your body has reached its natural limit for an activity.

PD: It’s quite hard to tell someone that their body or mind is not good enough to be the sportsperson they want to be. That is something that all of us face who have participated in sport. If you are a soccer player you must be able to use both feet, and jump, and run fast, and score from multiple angles, and manage pressure. Some people cannot, and they reach their natural barrier mentally or physically, either with an injury or mental lapse. With the TUE system, you artificially get around those natural barriers. So ethically, where does it stand against other forms of enhancement?

VN: What type of response have you gotten from your essay?

PD: Just the usual keen Twitter responses. I’ve had a few people email me and send me messages on social media saying this is a terrible idea. They need painkillers or certain asthma medication, and they say it would be unfair to those individuals. There has been more disagreement than agreement, I’d say. But there are other people who agree with my logic. I think it really depends on where you start from.

VN: My guess is this type of policy change would be extremely controversial to actually enact.

PD: I’m not pretending this would not be difficult. It would not be an easy conversation with athletes, that’s for sure. But isn’t that just what happens in elite sport? People get dropped or substituted due to performance. Their contract ends. It’s going to happen to everyone at some point in their career. Nobody goes through a sports career with just good news, right?