Responding to the debate on Therapeutic Use Exemptions in general and Marcel Kittel’s remarks in particular, Team Novo Nordisk CEO Phil Southerland has called for a more nuanced discussion on TUEs plus a better understanding of the circumstances for diabetics in sport.

Earlier this month Kittel commented on TUEs, suggesting that those needing such exemptions to take otherwise banned medications should not be allowed compete in standard competitions.

“If someone has serious asthma, they do not belong in high-performance sport,” he said, apparently referring to the circumstances of the Bradley Wiggins case without naming the rider. “The Paralympics were introduced so that those with one leg could have the chance to compare themselves against others. It is logical that they would not have a chance against those with all their limbs. But they have the chance to measure themselves against others on the same level.

“If someone has serious breathing problems, then for me he does not belong in that group, because he needs help… If someone has a bad asthma attack, then he either can’t be a high-performance athlete because it is chronic or, if it just happens occasionally, then he has to leave that competition.

“If I crash and break my collarbone, I can also take 100 pain pills, but I am in fact ill and have to abandon the race.”

Southerland’s team is comprised of riders who all have type one diabetes. These all need daily shots of insulin and, because it is otherwise a banned medication, are granted TUEs because of their condition and the necessity of the injections.

While he believes a debate is necessary, he emphasises the need for nuance and understanding in that debate.

“I have seen all the banter going back and forth,” Southerland told CyclingTips. “I think there is some healthy discussion in it as there are obviously flaws in the system. But when you see Kittel saying that anyone with a TUE should be in the Paralympics, it was short-sighted. He has got a big audience and people listen to him.

“For me, it was a shot at people with diabetes and a lot of people who need TUEs to have a chance to compete. There is a difference between corticosteroids and insulin. For my riders, a TUE is life and death.”

Southerland states that he has great respect for those in the Paralympics. “They are people who have overcome a lot, and are working with limited capability because they don’t have one arm, they don’t have a leg, they can’t see. The Paralympics give them a chance to compete.”

However he said that it is possible for those with diabetes to compete at the top level of sport. “We have seen Olympic gold medals from athletes with the disease. Steven Redgrave, Gary Hall Jr to name a couple. There are athletes with diabetes competing on the very highest of levels on all sports around the world. There are college scholarships for 91 athletes with diabetes competing in NCAA sports here in the States.

“It is an autoimmune disease and from the moment the are diagnosed to the moment they die, they will be given insulin. That is the state of the game.

“So to say to all the kids out there that they should never dream of competing in professional sports because they have diabetes is insulting. Maybe we should ban hair gel..!”

Eliminating the grey area:

The UCI’s website includes a declaration as to how many riders have had TUEs in recent years. These figures are as follows:

2009: 239

2010: 97

2011: 55

2012: 46

2013: 31

2014: 25

2015: 13

The figures show a clear drop year on year and were reported by many media outlets lately when the subject of Bradley Wiggins’ TUE’s for an injected corticosteroid became public.

However the figures appear to be misleading.

A total of 17 riders competed this season with Team Novo Nordisk’s Pro Continental team. There were an additional seven competing with the women’s Elite team, plus various other squads including development and junior teams.

All of these require TUEs for insulin. They monitor their blood sugar levels in and out of competition, taking insulin when necessary to keep their blood glucose levels within a healthy range.

According to Team Novo Nordisk, its riders apply directly to the UCI’s Cycling Anti Doping Foundation (CADF) for their TUEs. As a result, a declared TUE figure of just 13 for 2015 couldn’t possibly cover the athletes using insulin. CyclingTips recently sought clarification on this matter from the UCI, but it didn’t reply.

It is possible that the figures refer to new rather than ongoing TUEs; if so, this clarification is not listed in that section on the UCI website. Without that, the true extent of annual TUE use appears to be unclear and underrepresented.

Insulin-dependent riders aside, Southerland accepts that there is need for debate and deliberation on this whole issue.

“Clarification needs to be had. A TUE for performance enhancement is not the objective,” he said. “TUEs are meant to overcome sickness or an ongoing autoimmune disease such as diabetes. But you can’t be using TUEs to get stronger and faster over the course of a three week race. That doesn’t work.

“That is that grey area that was mentioned in Millar’s article [former pro David Millar recently wrote a piece about using TUEs to cheat, as published here in the New York Times]. I think we need to eliminate that grey area.”

Asked as to his own ideas how to tackle the grey area, Southerland pointed to the regulations of the voluntary anti-doping MPCC. It includes Team Novo Nordisk and 16 other Pro Continental squads, seven WorldTour outfits, 17 Continental teams and seven women’s teams.

Wiggins’ former Team Sky is not and never has been a member, thus enabling them not to be bound by the stricter rules.

These rules include not using injected intra-articular corticosteroids in competition or within eight days of the start of a race, and also agreeing to sit out races if cortisol levels are abnormal.

The latter can be affected after corticosteroid use.

“You can see what the MPCC is doing,” said Southerland. “That is an organisation that we have been a part of from the onset. It is trying to ensure that riders’ health is looked after, first and foremost. If you are looking at the long-term best interests for the athletes when you make the judgement call on can we have them race or not, that needs to be the priority.

“With low cortisol levels, riders who are part of the MPCC are forced to sit out races.”

Southerland added a proviso to his statement. “I don’t want to also speak from a lack of education from an other medical perspective, but people have asthma and asthmatics should be able to race. If it is an ongoing disease that you need treatment for that doctors say you can compete, you just need this treatment, then that is okay.

However the grey area is when said drugs also bring about a boost in performance. “To do drugs knowing that you are going to be stronger and lighter in ten days but it is also going to fix a knee problem…well, we have to find out where that line is. And there has to be strict enforcement of the line.

“Exceptions can’t be made to very high profile athletes because they are on a team that has a lot of influence on the sport of cycling.”

Moving forward from this point, he states that he believes the establishment of an independent committee to study the issue could be a step forward.

“You look at specialists within the sport, outside the sport, who could come to some consensus on where that line is and then we agree on it. Then we leave it on the UCI, the MPCC and on WADA to enforce.

“I think it goes beyond this sport. It is not just about cycling. This is something that the sport of cycling could lead a global charge for all sports out there.

“I think there are questionable things being done in all sports and I think that cycling has been the most visible, especially in the last ten years in its fight against doping. Maybe this is something that we can be a key part of: setting up what it is going to be like for the next ten years for the athletes out there.”