Fancy bears. It sounds like a new range of jelly sweets, or a Victorian circus act. Thanks to some Fancy Bears leaking confidential therapeutic use exemption (TUE) information online, these have been dark days for cycling. Suspicion has been thrown over the achievements of several British athletes – not least Sir Bradley Wiggins, the first ever British winner of the Tour de France, and his use of triamcinolone acetonide – a powerful cortisone that David Millar described as the “most potent” drug he used in his career.

Sky broke no rules, apparently, though they have not so much butted up against their own thin blue line as fully stress tested its elasticity. For now, questions remain unanswered. Sky have promised to release details of further TUEs, with riders’ consent – this is confidential medical information, after all – a move that WADA has been quick to condemn.

The system, it seems, is broken and it needs fixing. In 2009, WADA removed the need for a TUE for Salbutamol, the most common asthma treatment drug, and application numbers tumbled. Salbutamol is not a one-size-fits-all solution for asthma – where Wiggins had a number of TUEs for Salbutamol before 2009, fellow sufferer Chris Froome did not – but Wiggins’ use of a different treatment before his three major assaults on Grand Tours can’t help but raise eyebrows. Not least because it is the same substance for which Lance Armstrong infamously tested positive in the 1999 Tour.

In 2011 L’Équipe released the UCI’s leaked “Index of Suspicion” for the previous year’s Tour de France, detailing their view of every rider in the event. The list was widely ridiculed for presenting the information out of context, but what went unremarked was an accompanying column by Gerard Guillaume, team doctor at the Francaise des Jeux team. Cycling, he said, was now running not at deux vitesses but three – PEDs, pan y agua and cortisone.

Cortisone use – and abuse – in cycling isn’t new. Cortisone was first isolated in the 1930s, then synthesised in 1949 at the Mayo Clinic in the US as an exceptionally effective treatment for rheumatoid arthritis. In 1950, the Nobel prize in Physiology or Medicine went to Philip Hench, Edward Kendall and Tadeus Reichstein for “discoveries relating to the hormones of the adrenal cortex, their structure and biological effects.”

A naturally occurring hormone released by the body’s adrenal glands to combat stress, cortisone – and other corticosteroids such as prednisone – suppress inflammation and release energy necessary for the “fight or flight” reflex, and are widely used in the treatment of asthma and injury. Cortisone injections are not uncommon in other sports – Andy Murray has openly discussed having an injection in his arm before a match against Rafa Nadal, and Steven Gerrard and John Terry were both prescribed the treatment to get them on to the pitch.

But cycling is different. Cycling has been the test bed for unlicensed products and therapies, the early adopter of anything that might give a rider an edge since Maurice Garin and his confrères lined up outside the Reveil-Matin in 1903 for the first Tour de France. By 1960, only 10 years after Hench et al were shaking hands in Oslo, Tour de France race doctor Robert Boncour was warning that cortisone presented “appalling dangers threatening the life of the champion-guinea pig turned into the champion-suicide.” In 1969, Dr Lucien Maigre was singing the same tune, declaring that numerous riders were routinely using cortisone in their preparation for the Tour. Just two years after Tom Simpson’s amphetamine-fuelled death on Mont Ventoux, the peloton had already moved on to the next big thing.

Eddy Merckx and Bernard Thévenet racing at the Tour de France in 1975. Photograph: AFP/Getty Images

When Bernard Thévenet was rushed to hospital in 1977, after winning the Tour de France for a second time, he was suffering from a catastrophic failure of the renal glands. A year later, the Peugeot rider revealed that he had been using cortisone since 1975 – the year he comprehensively thrashed Eddy Merckx at the Tour. His team-mate, Jean-Pierre Danguillaume, later told cycling journalist Pierre Chany: “Bernard found himself alone in hospital and he was scared. That’s what drove him to speak out.”

François Bellocq, the Peugeot team doctor from 1974 until 1979, was infamous for dishing out prescriptions even though he was not a qualified doctor – he used his father’s stationery and was thrown off the FFC medical commission for his pains – and for the development of hormone rebalancing therapy. In his 1991 book Sport et Dopage, Bellocq expanded on his theories. He likened riders to car engines running on water, oil and gas: “The human body needs an electrolyte balance, metabolic and hormonal, to run at its best.”

Over the course of a race, a rider’s levels of hormones will naturally fall. Bellocq advocated rebalancing those levels. If the body couldn’t replace what was lost quick enough, he thought it was permissible to top that level up to its natural state. Hormone rebalancing therapy would replenish the reserves that the demands of professional sport had depleted.

Was it doping? Bellocq was emphatic: “Doping brings to a body what it does not have in its natural state, or that he has naturally but in doses that pass all understanding.” The use of cortisone, which had brought Thévenet so low he said he was in no fit state to even get on a bike, was merely to delay fatigue in riders who were already putting their health at risk by facing the demands of a Grand Tour.

Cortisone sits at that uncomfortable intersection between recovery and doping to win, situated on the graph somewhere between unethical and not quite illegal. 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?

Should cortisone be seen as treatment or a licence to cheat? It’s the thinnest of lines, as Joe Harris and Steve Maxwell point out in an opinion piece for the Outerline: “Pro cycling has tended to focus on what is best for its economics rather than what is best for the affected or ill individual,” they argue. “And this in turn tends to push TUEs in the direction of sanctioned doping.”

When the UCI first made concerted efforts to control EPO abuse with the introduction of the 50% hematocrit rule in 1997, which required riders whose hematocrit was above that level to take an eight-day “rest” or have a sound medical explanation for why it was that high. In the new guidance on TUEs, a similar rest period has been proposed. The MPCC (Mouvement Pour un Cyclisme Credible) introduced an eight-day “health break” for use of intra-articular corticoids as part of their platform of anti-doping measures when they formed in 2007. They’ve subsequently added cortisol testing to their armoury, requiring riders from MPCC teams to pull out of competition if their levels fall too low – Chris Horner fell foul of the cortisol test in 2014 and was forced to withdraw from the Vuelta, and the opportunity to defend his crown. If a rider is ill enough to require emergency corticoid therapy, runs the argument, then they are too ill to race.

As Sky’s critics are quick to point out, the British team who championed “zero tolerance” and marginal gains have never sought membership of the MPCC. As MPCC doctor Armand Mégret said in a recent interview, had Sky been a member of the MPCC, Wiggins would never have started the Tour de France. The eight-day rest period is an attempt to eliminate the grey areas associated with TUEs.

Bradley Wiggins stands on the podium with Chris Froome and Vincenzo Nibali after his victory in the 2012 Tour de France. Photograph: Jerome Prevost/AP

After Thévenet’s revelations in 1978, a string of riders also revealed they had used cortisone. Roger Pingeon, winner of the ill-fated 1967 Tour, told L’Équipe: “We take products that dope the surrenal glands and we feel great and we can push a big gear, and we forget that the surrenal glands no longer work properly and the secondary effects are terrible.” Jacques Anquetil, the man who said “everybody takes dope” and that he’d had so many injections “my arse looks like a sieve”, declared he had tried cortisone twice. Luis Ocaña, whose one positive test in 1977 was for the stimulant pemoline, declared that cortisone abuse was “very serious”, saying: “It was 10 times better, a thousand times better to take amphetamines. It was infinitely less dangerous”.

Despite the warnings, cortisone refused to go away. In 1984, Dr Freddy Safar told Medicale magazine “I have 16-year-old kids who inject cortisone before a local race, all that to win a salad bowl.” Its use was alleged across a raft of sports – in gymnastics to hold back growth, in alpine skiing to combat fatigue and in athletics to speed healing. After a red-eyed, hyper-muscular Ben Johnson decimated the world record at the 1988 Seoul Olympics and then tested positive for anabolic steroids, it was revealed he had also used cortisone to heal an old leg injury.

But while athletes were prepared to play fast and loose with their long-term health – the known side effects of prolonged cortisone use include osteoporosis, cataracts, muscle weakness, mood swings and psychosis, diabetes, high blood pressure, ulcers, necrosis of the hip and thinning of the skin – cortisone use was not formally proscribed for competition until 1987, when it appeared on the IOC banned list under “substances subject to certain conditions”.

Before WADA became the umbrella organisation for anti-doping in 1999 and published their code and banned list, cycling had dealt with cortisone in its own way. The French “loi Herzog” of 1966 – a law that Tour de France doctor Pierre Dumas had been so instrumental in achieving after a string of doping near misses at the race – classified oral corticoids as “toxic” and banned their use in competition outright. But enforcement of the law – the first real attempt at anti-doping legislation in France – was negligible at best.

In 1968, the UCI placed “hormones and hormonoids” on the B list: to be used only with a doctor’s certificate. By 1970, the category was dropped – only detectable products would face a ban. In 1978, the UCI recognised corticosteroids as a distinct category and restricted their use for Olympic competition. The IOC did not agree, citing the impossibility of distinguishing between naturally produced and artificially introduced cortisone in laboratory testing.

Lance Armstrong wearing the yellow jersey in 1999. Photograph: Joel Saget/EPA

All that changed in 1999. At the start of the 86th Tour de France at the Puy de Fou, that extraordinary historical theme park in the west, Hein Verbruggen – who was head of the UCI at the time – announced at a press conference: “This year, the National Laboratory for the Detection of Doping will give the results of its research concerning the detection of natural and synthetic corticoids.”

Testers were now able to employ the technique of mass spectrometry on a rider’s urine sample and better analyse its chemical make-up. Armstrong was unlucky – caught out by the new test, he returned a positive for triamcinolone acetonide and then produced a hastily backdated doctor’s note to explain its presence. It was a cream for saddle sores, he argued, and the UCI, still smarting from the Festina affair, were happy to agree. In fact, Armstrong returned four positives in the race – but thanks to the opaque rules regarding cortisone use in force at the time, he avoided further sanction.

And there’s the rub. Since 1999, the use of glucocorticoids by oral, intravenous, intramuscular or rectal routes has been prohibited by the UCI, IOC and under French anti-doping law, prohibitions written into the WADA code. But the test cannot distinguish between administration routes, it simply knows that the substance is there. According to Dr Conor McGrane, fellow of the faculty of sports and exercise medicine at the Royal College of Surgeons, it is hard to differentiate synthetic corticoids from natural ones, “also cortisone levels fluctuate throughout the day as well – they’re lowest in the morning - so depending on what time you test you will get a different level.” This, McGrane believes, is one of the reasons that cortisone use has never been banned outright.

To regulate the way corticoids are administered, the simple doctor’s note has morphed into the Therapeutic Use Exemption (TUE). In the UCI’s anti-doping regulations for 2012, articles 46.4 and 47 bear examination. Between them they state that, when a TUE is granted, there should be “no reasonable therapeutic alternative” to the proposed therapy and that it should not “produce enhancement of performance” beyond a “return to a state of normal health”.

Dr McGrane points out that the British Association of Allergy and Clinical Immunology say injections should only be used as a last resort and even then the side effects may outweigh any benefits. NICE guidelines for rhinitis treatment do not mention intramuscular corticoid therapy at all, instead advocating the use of orally or nasally administered cortisone.

The evidence on performance enhancement is anecdotal – a chorus of convicted dopers from Millar to Jorg Jaksche to Michael Rasmussen have all raised doubts about using such a powerful drug – but for clarity, it should be stated that triamcinolone, which was prescribed to Wiggins before three major competitions, is a performance-enhancing drug and sits on WADA’s banned list. Besides its therapeutic usage, it causes rapid weight loss with no loss of power, a sense of euphoria and effectively deadens pain. This is why its use is only acceptable, therapeutically, with a TUE. Yet the regulations seem purposely vague, allowing for considerable wiggle room and unscientific value judgements. Who can honestly say what is one rider’s “state of normal health” and another’s “enhancement of performance”? We have no way of evaluating either.



More troubling is whether the UCI followed its own rules concerning approval by the TUEC – the three-person committee who are charged with signing off TUE applications. When I contacted the UCI in the wake of the controversy surrounding the approval of an emergency TUE for Chris Froome at the 2014 Tour of Romandie, I was told by a UCI spokesperson that “it was common practice that, for straightforward cases such as asthma, allergic reactions, post-infectious coughs, sinusitis, the UCI’s doctor was making the decision.” That doctor was Mario Zorzoli.

Followers of the darker back alleys of the sport will recognise Zorzoli’s name from the UCI-commissioned CIRC report, which contained quotes from Rasmussen in which he alleged that Zorzoli and Leinders had colluded to ensure that the Rabobank team would sidestep all doping-related issues. Leinders was banned for life in 2015 but, after the UCI investigated Zorzoli and found no evidence to support the claims against him, he was reinstated to his position.

As for mismatching dates on Wiggins’ leaked TUEs, his biographer William Fotheringham offers an interesting explanation, presenting a picture of a Team Sky greatly at odds with the methodical, micro-managed unit familiar from team PR. It raises some interesting questions about Sir David Brailsford – is he the meticulous Blofeld of international cycling as his detractors paint him, or a somewhat naive cycling aficionado so in love with the sport he is blind to its faults, unaware of Thévenet’s story and the long, murky past of cortisone abuse?



Dave Smith, the former Olympic coach who trained the French star Pascal Lino at the end of his career, is forthright in his condemnation of the current TUE system, calling the controversy around Wiggins “an embarrassing shit-show for Sky.” He questions whether Brailsford, who raced for a French amateur team in the 1980s and has lived through the Armstrong era, “is fit for the position he finds himself in if he lacks such insight.”

The answer may be moot, with news that UKAD are investigating Team Sky for receiving medical products at the 2011 Critérium du Dauphiné – the same race where Dr Richard Freeman picked up the phone and was granted an emergency TUE for Rigoberto Uran by Dr Zorzoli. There is a sense of panic and disarray around the Death Star, with the usually slick PR operation in crisis after being caught out in some fundamental mistruths, particularly their Brailsford mistakenly suggested that Simon Cope had travelled to La Toussuire to meet Emma Pooley, who had been hundreds of miles away racing in Spain. She called his claim “silly and careless”, though one wonders how her reputation might have suffered had she not had a cast-iron alibi.

Meanwhile, UCI president Brian Cookson, the man who oversaw the development of Team Sky as the head of British Cycling, has absolved the team of any wrongdoing. The UCI have promised a full review of the TUE process but, while the ethical grey area remains and the Venn diagram of cheat and treat remains unresolved, the TUE process will continue to be seen in the same light as the old 50% haematocrit level – as a licence to cheat by those who are happy to cross the line.

• This article is from 100 Tours 100 Tales

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