Must-read of the week: The Doping Ordeal of Lizzy Banks

[benb]

Originally Posted by Likes2ridefar

According to this paper asthma is more prevalent in elite endurance athletes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9633848/

“Asthma in elite athletes – do they have Type 2 or non-Type 2 disease? A new insight on the endotypes among elite athletes”

Interesting.. doesn't seem like they actually filtered out elite athletes who might not actually have asthma but went through the typical process to get themselves declared as having exercise induced asthma since it's a fuzzy definition and the study even mentions only indirect observations are used in athletes.

I read these studies and it is 100% in my mind if I really wanted to I could get the diagnosis (especially after riding hard in cold weather) and it would give me a little performance boost and/or let me train higher volume, but the symptoms are absolutely minor and don't really require treatment.

It's all in how you define it as a problem, how much exercise you're expected to be able to do in a certain amount of time, how much symptoms is tolerated, and what society's expectation for treating it is or what the athletic communities expectation is. Lots of us have an expectation that we can do anything we want and if there is a side effect we should be able to take something to fix it.

If they said no TUEs for EIA there would still be pro cycling.. it might still be mostly the same people making it to the top. But there might be slight differences in who was there too.

[jds108]

Originally Posted by tootall

Crazy stuff to read.

Somewhat related; has anybody ever noticed the seemingly high incident rate of elite cyclists with Asthma?

In my university aged years I was cycling a lot including entry-level crits. Cycling was the only activity that would trigger my Asthma (so it was exercise induced asthma, EIA).

Just one data point, nothing more.

[Alistair]

Originally Posted by prototoast

I've said it before and I'll say it again, the biggest shortcoming with the anti-doping procedures is that there is no control group. We simply don't have any idea how often a person who isn't a world class athlete, without incentive to dope, could test positive from some sort of contamination.

This. Strikes me that there a few possibilities for the low-dose/contamination stories...

1. The athlete really was doping (or masking doping)
2. The athlete ingested a tainted supplement
3. The athlete had "environmental" contamination

#3 would show up in a large enough control group. Or, at worst, a control group would show the likelihood of *some* controlled substance being randomly found in the general population.

#2 should be provable via control tests of supplements. Again, maybe not for a specific drug at a specific time, but at least a general sense of the likelihood.

[EB]

In the United States, the supplement world is a regulatory Wild West, for which you can thank the former senator from Utah Mr. Orrin Hatch (RIP). As a result, supplement contamination, often with banned steroids, is a well-known problem in the US.

However, I am not sure if this is a problem outside the US where they may be tighter controls and regulation on the content and distribution of nutritional supplements. Does anyone here know?

[pdonk]

In her post Banks highlights that the diuretic she tested positive for (at a level below recognized thresholds) is not a particularly good one to use if you plan on masking your use of another substance due to how long it stays in your system.

I'd be very interested in reading case / decision as presented by UKAD. I've read quite a few from CSES and they tend to be very clear about what happened and the reason for the decision. If the decisive language is to be believed, the settlement statement will be a good read.

[benb]

Originally Posted by EB

In the United States, the supplement world is a regulatory Wild West, for which you can thank the former senator from Utah Mr. Orrin Hatch (RIP). As a result, supplement contamination, often with banned steroids, is a well-known problem in the US.

However, I am not sure if this is a problem outside the US where they may be tighter controls and regulation on the content and distribution of nutritional supplements. Does anyone here know?

She mentions in the article she was shipping her supplements in from overseas because she was afraid of this stuff.. but it's unclear to me which country she thought she couldn't trust supplements in & from. I think she meant she thought she'd get popped for drugs if she bought supplements in France and so she ordered them from the UK and had them shipped in?

Again a whole weird scenario. Do they all need to take "supplements"?

She doesn't seem to make a case for it being supplements, I think because she couldn't find evidence that drug had been found in supplements. She was basically going on a theoretical risk of contamination that would cause detectable amounts of the diuretic in other prescription drugs she took.

I suspect from calling pharmaceutical companies over my son's prescription meds that the drug companies are just doing legalese and science talk. When I have called about prescriptions my son needs basically none of the companies will guarantee their product doesn't have gluten in it. And his prescription is a controlled substance, so they damn sure know what goes in that drug. I suspect they are just trying to cover themselves. I have talked to the pharmacist about this and they basically indicate the drug companies won't guarantee anything. But they have to pass all the regulatory tests... so it's a sure thing they are more careful than supplement makers. FWIW for every manufacturer who says they won't say if the Rx has gluten in it (every one) none of them have made my son sick or cause him to come back on a blood test that he had gluten. (He has celiac and he gets really violently ill if he has gluten)

I think a big difference in her case is she knows a lot more about the medical system than the typical pro cyclist as she dropped out of medical school in her last year to do cycling. She probably really regrets that.

[m_sasso]

Originally Posted by Xrslug

This reminds me of the story of a Canadian junior cyclist that I heard recently on a podcast. Tested positive for a diuretic, Given the number of environmental contaminants, I don’t know what to make of stories like this. “Burke tested positive for less than one billionth of a gram. Few labs can even detect quantities this small, but Burke’s sample was sent to the WADA-approved INRS lab near Montreal that has this capability. After exhaustive research and some expert advice, indications pointed instead to the hypothesis of unintentional ingestion of contaminated water from the Abitibi town of Malartic.”
https://pedalmag.com/jack-burke-fina...r-de-labitibi/

If you read her story she used referance to the Jack Burke incident as part of her defence. https://jurisprudence.tas-cas.org/Sh...ments/3370.pdf

[prototoast]

Originally Posted by Alistair

This. Strikes me that there a few possibilities for the low-dose/contamination stories...

1. The athlete really was doping (or masking doping)
2. The athlete ingested a tainted supplement
3. The athlete had "environmental" contamination

#3 would show up in a large enough control group. Or, at worst, a control group would show the likelihood of *some* controlled substance being randomly found in the general population.

#2 should be provable via control tests of supplements. Again, maybe not for a specific drug at a specific time, but at least a general sense of the likelihood.

And even conceptually, "supplements" covers so many things. Are we talking about a Flintstones chewable multivitamin or a GNC muscle-building whole body super supplement? It's always a little funny to me when athletes are like "this supplement that I was taking to improve my performance was accidentally contaminated with a substance that would actually improve my performance."

[72gmc]

Originally Posted by jds108

In my university aged years I was cycling a lot including entry-level crits. Cycling was the only activity that would trigger my Asthma (so it was exercise induced asthma, EIA).

Just one data point, nothing more.

It was running cross country for me, on hot days. Pretty sure I can still trigger it cycling on hot days but I try to be smart enough to avoid going that hard ...

[zennmotion]

Originally Posted by benb

I think one of the problems (and this is true with ADHD) is that it's too easy to get a diagnosis and medications and then the TUE just by answering the questions correctly.

My child has ADHD so we've been through that.. the bar to get yourself declared as having ADHD as an adult is actually lower than for a child. You just give the right answers and you've got your drugs, and IIRC you don't have to have quarterly doctor appointments to re-evaluate like kids do, and they certainly don't require your employer or others to check in with the doctor the way the school has to with kids.

I'm not trying to derail the thread, and I won't engage further, but as someone who lives with ADHD, diagnosed nearly 20 years ago (with some of its other frequent and challenging comorbidities), I'll just clarify the erroneous connection made here to PEDS, based on what I know from my own experience and reading. There is no need to "re-evaluate" adults, once diagnosed, as ADHD is a congenital condition that doesn't get somehow "cured". It's a "real" thing with a growing body of research behind a growing understanding of what's going on, primarily in the pre-frontal cortex, visible in brain scan imagery, that affects multiple executive function differences compared with neurotypical brains, including body centering and balance which explains my failure at all non-endurance sports. I wish I had the diagnosis and access to treatment including meds while I was still in school, it would have been life changing even for someone who also tested very high IQ (which is also common with ADHD, not yet well understood). As an adult, my meds provider (a specialist Psychiatric nurse as my Primary Care provider won't write scrips for ADHD stimulants) can only write an RX for a 30 day supply of a Schedule 2 controlled substance. And she requires a video check in every couple of months to re-evaluate the prescription choice and dose, not the condition. I don't doubt that there's some lack of accountability and oversight with some providers/patients but there is no widespread conspiracy around ADHD meds. As for my employers, in most cases it would be career suicide to bring it up, given the common ignorant stereotyping despite the frequent outside-the-box problem solving and dot-connecting ideas I bring to my work teams. Just don't expect me to be consistent with submitting my expense reports on time every month...

[Alistair]

Originally Posted by prototoast

And even conceptually, "supplements" covers so many things. Are we talking about a Flintstones chewable multivitamin or a GNC muscle-building whole body super supplement? It's always a little funny to me when athletes are like "this supplement that I was taking to improve my performance was accidentally contaminated with a substance that would actually improve my performance."

Yeah, that's definitely a fair point as well.

To me, supplements are things like vitamins, creatine, protein powders. But there's definitely a whole world of things that butt right up against "drugs". And everything in between (ketones, etc).

[benb]

Originally Posted by zennmotion

I'm not trying to derail the thread, and I won't engage further, but as someone who lives with ADHD, diagnosed nearly 20 years ago (with some of its other frequent and challenging comorbidities), I'll just clarify the erroneous connection made here to PEDS, based on what I know from my own experience and reading. There is no need to "re-evaluate" adults, once diagnosed, as ADHD is a congenital condition that doesn't get somehow "cured". It's a "real" thing with a growing body of research behind a growing understanding of what's going on, primarily in the pre-frontal cortex, visible in brain scan imagery, that affects multiple executive function differences compared with neurotypical brains, including body centering and balance which explains my failure at all non-endurance sports. I wish I had the diagnosis and access to treatment including meds while I was still in school, it would have been life changing even for someone who also tested very high IQ (which is also common with ADHD, not yet well understood).

ADHD drugs absolutely have a history as illicit abused drugs and as PEDs for academics and STEM fields. There is a reason they are Class II controlled substances.

We just got through a huge shortage of the medications due to adults getting diagnosed at outrageous rates through online tele-health single visits during covid. The FDA has apparently cracked down on the online pharmacies and mental health online providers that were handing out RXs like Candy. That was a *massive* PITA for parents with kids with ADHD the last few years though. It was incredibly hard to fill prescriptions.

I don't know what they are doing that tightened it down for adults but realistically the protections they have for kids probably make sense for adults too.

Most people here probably have never had to fill a controlled substance maintenance prescription on a monthly basis.. just know it is a huge PITA.

[FriarQuade]

I'll never understand why cycling fans want to destroy the sport to vilify dopers. Road racing was way more entertaining when they were all juiced to the gills anyway.

[GregL]

Originally Posted by earlfoss

It's always a good idea to read defense tomes like Lizzy's with a critical eye. Many athletes at this level aren't healthy mentally or emotionally. As a former elite racer who has seen a lot over the decades, I believe asthma inhalers are abused by athletes. I was one of them for a short time. Honestly, they never worked for me but I didn't have actual asthma either. Neither did 99% of the athletes I knew who were using them.

I had a close, personal relationship with a pro athlete. Without doubt one of the most messed up people I ever met. Their OCD issues associated with their sports are often a way to run/swim/bike away from deep seated emotional problems. So much of their identity is tied up in their sports that they will do anything to win.

Greg

[zennmotion]

Originally Posted by benb

ADHD drugs absolutely have a history as illicit abused drugs and as PEDs for academics and STEM fields. There is a reason they are Class II controlled substances.

We just got through a huge shortage of the medications due to adults getting diagnosed at outrageous rates through online tele-health single visits during covid. The FDA has apparently cracked down on the online pharmacies and mental health online providers that were handing out RXs like Candy. That was a *massive* PITA for parents with kids with ADHD the last few years though. It was incredibly hard to fill prescriptions.

I don't know what they are doing that tightened it down for adults but realistically the protections they have for kids probably make sense for adults too.

Most people here probably have never had to fill a controlled substance maintenance prescription on a monthly basis.. just know it is a huge PITA.

"Getting diagnosed at outrageous rates" you mean to imply that many/most of them are faking it? Official diagnosis is much more precise and thorough now than when I was first diagnosed (through a 3 hour peer-reviewed questionnaire, followed later by physical testing and later still by a brain scan). I think a much more likely explanation of most of the uptick resulted from adults who were suddenly forced to work from home (with kids), or otherwise isolated, without the normal stimulus of office environments, face time with colleagues/clients/customers, staring at computer screens with all the online distractions, skyrocketing anxiety (like everyone else but multiplied as ADHD and anxiety go hand-in-hand). No surprise that, given the changing reality of Covid, so many that were managing pre-Covid were desperate for lifelines including ADHD meds that require an Rx. My issue is that your skepticism seems to be reflect a worldview that many/most adults seeking diagnosis and treatment are somehow illegitimate or cheating. The FDA, which provides oversight over Schedule 2 drug production and/or distribution in the US, has repeatedly effed up big time by reading and manipulating the demand projections wrong, and (insert conspiracy here, although supported by data and clear causal connections) it's coincidental with Big Pharm lobbying the FDA to maximize profits for some medications by throttling cheaper imports, taking advantage of the new Covid and post-pandemic realities. Shocking, I know...