The Truth About Tues

With suspicions lingering over the deployment of Therapeutic Use Exemptions, Dave Smith weighs medical need against the potential abuse of grey areas

- Dave Smith

There are many medications and drugs that cyclists who compete under UCI and national governing body rules are not permitted to use. With some substances, such as EPO and anabolic steroids, the reason is obvious: they enhance performance. However, there are also numerous prescription and over-the-counter medications that can trigger a positive test — even, until a recent change in ingredients, the apparently innocuous cold remedy Lemsip (it contained the banned stimulant ephedrine). If a racing cyclist really needs such a remedy to restore health, he or she requires a therapeutic use exemption (TUE).

Medications are placed on the banned list either because they boost performance or present risk to an athlete’s health (or both). When the only effective treatment for an illness is a prohibited substance, a TUE permits its use to treat the illness or injury, or to ensure that an ongoing medical condition is not a barrier to competition.

In practice, there are rules that have to be followed. The problem, as we will see, is that the process can be abused. Some riders steer clear of TUEs because of the grey areas. Famously, Jonathan Vaughters refused to apply for a TUE for steroid cream after a bee sting to the eye. Though the treatment would have worked, he was unwilling to use a prohibited substance — even with permission. In similar circumstances in 2011 and 2013, Fabian Cancellara was granted TUEs for bee stings — and Trek-Segafredo subsequently released photos of his swollen face as legitimising evidence.

What are the rules on TUEs?