Tandon: Serena Williams Therapeutic Use Clearance

While Serena Williams protests against what she describes as excessive doping tests, her relationship with the anti-doping rules has been examined more closely.

Tuesday, via Twitter, Williams drew attention to the latest drug test. she received anti-doping authorities. In the eyes of the Grand Slam champion 23 times, the emphasis on it has been excessive to the point of "discrimination":

… and it is at this time of the day to test "Randomly" drugs and test Serena. Among all the players, it has been proven that I am the most tested. Discrimination? I think so. At least I'll keep the sport clean #StayPositive

– Serena Williams (@serenawilliams) July 25, 2018

But I'm ready to do whatever it takes to have a clean sport then bring it. I'm excited.

– Serena Williams (@serenawilliams) July 25, 2018

This is not the first time Williams and the anti-doping rules have been in the headlines.

In 2016, Williams revealed to have received several Therapeutic Exemptions (AUT) from the ITF. They were made public when Russian hackers entered the World Anti-Doping Agency (WADA) database and published confidential data on 29 athletes, including TUEs for Williams and other players from the World Anti-Doping Agency (WADA) database. tennis including Venus Williams, Rafael Nadal and Petra Kvitova. no suggestion that Williams broke any rules. According to specific requirements, WADA authorizes athletes to use substances otherwise prohibited for medical purposes.

But the TUEs granted between 2014 and 2015 could indicate the need to re-examine the system, according to a leading anti-doping expert. According to Richard McLaren, author of the McLaren report on Russian doping at the Sochi Games and a professor at Western University, more information is needed to badess whether errors have occurred during the process

.

"This is a problem that requires significant tightening," said Mr. McLaren. According to the published document, Williams received five TUEs in 2014 and 2015 for prednisone and prednisolone corticosteroids, and another TUE for a narcotic badgesic. oxycodone. Corticosteroids reduce swelling and inflammation, and also increase some physiological functions. Three other TUEs were also granted for similar substances in 2010, when Williams was hospitalized and was absent for an extended period due to injury-related complications

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Use Authorizations for Purposes therapeutics (AUT) by Serena Williams
/ Substance

* Oct 2010 – Mar 2011/23 Dec / Hydromorphone
* Dec 2010/23 Dec / Oxycodone
* Nov 27-Dec 1 2010/23 Dec / Methylprednisolone
* March 12-19, 2014/13 March / Prednisone
* 21-30 March 2014/2 Apr. / Prednisone
* 7-21 May 2014/8 May / Prednisone
* 10-17 Nov 2014/3 Dec / Prednisone, Oxycodone
* 5-10 June 2015/8 June / Prednisolone

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Most of these TUEs were retroactive, which means that they allow the use of the Prohibited Substance prior to the granting of the # 39; TUE. In some cases, the delay is just one day, while others are two weeks or more.

& # 39; & # 39; That should not be done, "McLaren said. & # 39; & # 39; You are not supposed to get retroactive TUEs except in case of emergency. There might be some explanations, but someone should look and see the explanation. "

According to the specifications of WADA, TUEs may be granted retroactively for" emergency "or" acute "situations, although they may also be authorized under" exceptional ". But Stuart Miller, the ITF official who runs the anti-doping program for tennis, said that was hardly known in tennis.

"It's not unusual to find a retroactive AUT "he said:" In a number of cases, it is not possible for them to obtain a TUE before needing the drug. The treatment of the athlete comes first. If the health care professional declares that the athlete's treatment should start now, because the athlete's health is in danger, he may apply for a retroactive TUE, provided that he meets the criteria [for TUEs].

"There are also other criteria, and one of them is an athlete who does not have the time or the committee [granting the TUE] did not not the opportunity to make a decision on a TUE before the next athlete competition.Players play every week, several times a week … they are not like marathon runners, who can run two marathons a year, which matters, is that they meet the criteria [for receiving a TUE] – that 's all This criterion is based on the International Standard for Authorizations. Therapeutic Use (ISTUE) of the AMA, which governs all Olympic sports and requires that the TUE be for a "significant health problem" and not for a significant effect on performance "and n & rsquo; Have no "alternative drug allowed." But the Williams AUT base is hard to gauge since most of the details are confidential [1965] 9003]

The health problems for which Williams received the TUEs are not publicly known or easy to establish. with the week leading up to the Miami Open 2014, the Miami Open 2014, the Madrid Open 2014, the Open of Italy 2014, the week before the event. Open de France 2014 and the Open de France 2015. Williams won all these tournaments except Madrid and the Open de France 2014 as well as five other titles between these dates.

In addition, Williams had a series of TUEs during the 2014 off season, although oral corticosteroids are prohibited only for use in competition.

During the 2015 French Open, Williams had a TUE for the use of prednisolone orally for five days from June 5 – the day before Roland Safarova-'s victory at the final of the French Open which took place on June 8th after the tournament. 03] Asked about the circumstances of this TUE in Indian Wells this year, Williams said: "I would not play unless I had a TUE because if you remember, I was incredibly sick.I said, I can not literally lay the final, but I need a TUE to take a decongestant. "

She also said that she had never been positive and that she would not cheat in general

. Williams said angrily that she would not answer any further questions on this or any other subject

Williams recounts that his illness is consistent with his visible cough during the tournament, as well as statements about his illness after his third round match. At first glance, it also seems against its need for a corticosteroid, which is a potent immunosuppressant, not something prescribed for a cold or a virus.

Still, it is sometimes prescribed to reduce the severe symptoms of a viral infection, and the ITF and WADA guidelines specifically include a category for post-infectious cough. It allows the use of an oral corticosteroid for a period of a few days, if the athlete used an inhaled corticosteroid and found it to be ineffective. 659003] But WADA guidance documents also suggest that a post-infectious cough usually occurs between three and eight weeks after an infection, and calls it a "subacute" condition.

It was not decided if corticosteroids should be prescribed during the infection. A 2017 study, published in the journal JAMA found that 40 mg of prednisolone taken for five days usually did not reduce the severity or duration of airway infection symptoms.

Still, the rules of AUT permit to consider any significant health problem, and Williams' application could have been for another condition that she did not recognize. publicly. Between 2014 and 2015, she appeared sick several times during tournaments, retiring from a doubles match at Wimbledon in 2014, with a viral illness in Wuhan in 2014 and, according to Williams, vomiting in the final from the Open of Australia 2015 she won against Maria Sharapova.

"I was just very sick, that's all I could say, and that's all," said Williams at New York Times after the # 39; Open from Australia. "I had a bunch of follow up tests in the fall to see why I was getting continually sick and dizzy and I felt like I was going to faint. I've got new vitamins, and I've been really good since "

Williams responds to comments on her about Sharapova's autobiography:

Williams recently spoke openly about other medical issues she's been experiencing, including surgery for the complications of childbirth in an interview with Vogue magazine Williams also mentioned in her interview that she used blood thinners every day because of her complications in 2010. Although they are not considered to improve performance or banned by anti-doping rules, they do not are not recommended for corticosteroids, which reduce

D & One way or another, athlete statements are not generally used to evaluate a TUE, said Miller. "If an athlete says" I'm sick, "it's not a factor that will go to documentation," he said.

The way TUEs are granted in tennis is healthy, says Miller. I actually think that the TUE system is very robust and that it has a number of security systems, "he said." That's not to say that it's not safe. It is theoretically not possible to circumvent these rules, but they are robust. "

The TUE award process requires that physicians submit claims on behalf of the athletes that they are dealing with. as well as supporting documentation, this justifies the application of the AUT.This is then reviewed by an independent group of doctors who do not know the identity of the athlete and decides to The decision is then entered in the AMA database, with WADA having the ability to reverse the decision.

WADA overturned a decision. TUE given by the ITF to Bethanie Mattek-Sands in 2013 and 2014, and Miller has already stated that this Indeed, according to Miller, the TUEs issued by pirates on It was shown that requests from tennis players were correctly granted.

"I have reviewed all the TUEs that were disclosed." There was nothing to indicate that the system had been bypbaded, "said Miller." There were authorizations to use substances that were commonly used

"Athletes are only members of the public to the extent that they have common conditions [and] need a drug to restore them to a normal state of health." Is the reason to be of the AUT system.This does not allow them to improve their performance, but to bring them back to a normal state of health. "

But this distinction between normal health and improved performance has become increasingly blurred.TUEs published in 2016 also included those of British cyclists Chris Froome and Bradley Wiggins It was confirmed that Froome had received a TUE for prednisolone in 2014, described as eta nt for a thoracic infection, while Wiggins received three in 2011, 2012, and 2013 for triamcinolone, a slightly more potent corticosteroid. Daily Mail revealed that Wiggins had received a package before a 2011 race, allegedly also containing triamcolone, but that Wiggins' Team Sky said it was the decongestant Fluimucil, which Wiggins had mistaken for pollen allergies

. British parliamentary inquiry, which concluded a few months ago that Wiggins injected triamcinolone not for "medical need", but to "improve its power" This led the committee to state that Team Sky had crossed an "ethical line" and showed that the TUE bike system was "open to abuse." Wiggins and Team Sky denied any misuse

.The effects of corticosteroids are even more anecdotal than established, the cyclist David Millar admitted taking them and said that they can have a noticeable effect on an athlete's physique in three days: "It's catabolic, so it's gnawing at you," he said. Guardian .

These cases and others have drawn renewed attention to the potential problems of AUT. Asked that such an awareness would have an impact. on how TUE applications will be evaluated, Miller said: "Every case it should be justified on its own merits and in the same way, the independent committee of AUT for the anti-doping program of tennis I do not know any other TUEs in another sport.

"They should and, as far as I am concerned, they should make a decision on each TUE based solely on information for the AUT. We provide them with other TUEs [anonymous] for the player concerned. "

More general concerns expressed by the British parliamentary committee are not part of the decision-making process, Miller adds.

" I'm not sure there's enough " information is not the criteria used to evaluate a set of ethical rules, "he said."

McLaren acknowledged that the TUE system is not equipped to carry out ethical badessments, but he said lessons from previous cases should be taken into account.

"Yes, absolutely, we all learn," he said, "they should come back and say that this happened, and what are we doing to make sure … that this does not happen? [they] should be obliged to do so by WADA, but WADA has so much regulatory stuff TUEs are a small part of a set of anti-doping issues more complex. "

But hacks are also not the way to uncover these problems, he added.

"The base is based on illegal activities" says McLaren, "I'm pretty suspicious when I see piracy … I wonder, what did they see and not reveal?" . He has a context.

& # 39; & # 39; I suspect that in all these cases there is a lot more context than in the public domain. I know it from my own work. I was amazed at some of the things we discovered in Major League Baseball, in the TUE area and elsewhere. Now, they have changed a lot today, to their credit. You must [to] have an independent audit from time to time. Not to check the athletes necessarily, but to check the processes. "

A few weeks ago, Williams and the anti-doping rules were back in the media when a story Deadspin Williams telephoned the CEO of WTA, Steve Simon, complaining that she was being targeted for testing, by being referred to the head of the US Anti-Doping Agency (USADA), Travis Tygart, following a visit from a police officer. USADA at Williams at his press conference prior to the tournament at Wimbledon, adding that the officer had not entered the "window location" for one hour during which the best Players must be at their designated location for potential testing. "

" For whatever reason, they showed up in the morning, what they are allowed to do, "said Williams, also confirming that" I'm not going to be there. " no samples were collected. "If I'm not there, then Hey, go away." for some reason, they did not leave. They said, I can come back. "

Williams said that she was" totally not in the area because my time is really long from now, "and had a conversation with Tygart Williams saying that she asked why she had been tested five times this season, which is more than other high-ranking players.

"I said, I'm fine, provided everyone is treated the same way, "she said

., In France, Williams' Twitter account had also said that she had had two tests that week:

And …… just like that , the anti-doping is here … again … second time this week.participate in keeping the sport clean, even if they test me at my current ranking of 454 in the world, twice a week #BeingSerena

– Serena Williams (@serenawilliams) May 21, 2018

Tennis players are subject to testing by both the ITF and their National Anti-Doping Agency, as well as by the country's national anti-doping agencies. where they are competing. Organizations do not publish collective data on the amount of testing between them.

Neither USADA nor the ITF has suggested that Williams be targeted – the best players tend to get tested more often, and those who play tournaments a lot also tend to have more tests in competition. Still, the anti-doping program of tennis consciously uses targeted tests, where players can be selected specifically for tests based on other information

"[It] would not do his job properly." 39, did not use information to maximize Williams, who dropped rankings during pregnancy, delivery, and recovery in 2017 and 2018, also appeared to be questioning her inclusion in the locator's program. ITF, which is usually limited to the Top 50 for singles players.

Including Williams was justified, suggested Miller, saying, "Among the selection criteria, there is the probability of winning competitions. "

It is not clear that these answers would satisfy Williams, but she seems to be asking more explanations to the anti-doping authorities than they have asked her or herself for." even

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