August 2018 – The 2018 edition of the Tour De France, yet again, showed the negative side of the public and their treatment of Chris Froome.
Chris Froome absorbs a barrage of abuse
How any society can consider it OK to spit at an athlete, while they are participating, and to throw urine at anyone based on what they read in newspapers and social media is ridiculous. But this is what they do, and the newspapers feed this disgusting social behaviour.
So how did we get here? How it is portrayed, is that Froome failed a doping test and that he is guilty, no matter the circumstances and the data which is available.
The adverse analytical finding from Vuelta 2017
An adverse analytical finding (AAF) is when an anti-doping authority identifies a potential breach in anti-doping rules, in this case a specified substance detected at a higher-than-allowed level by the Cycling Anti-Doping Foundation (CADF). CADF are responsible for doping control for the UCI.
Under World Anti-Doping Agency rules, riders are allowed a level of salbutamol of 1,000 nanograms per millilitre. However, Froome was found to have twice that amount in a urine sample taken during the Tour of Spain on 7 September.
Froome’s problem is that he exceeded the accepted level of salbutamol of 1000ng per millilitre in a urine sample on September 7 in one of around 20 such tests he gave during the Tour of Spain, which would be the equivalent of around four or five puffs on an inhaler. His reported level was 2000ng/ml.
These results were leaked to the press and that is when much of the problems arose. Whenever the press gets hold of doping information, it is actually detrimental to the process which is complex in nature and relies on numerous steps before guilt can be apportioned.
Froome and Team Sky were notified of the AAF and are then provided with the opportunity to give their reasons as to what caused the cyclist to exceed the accepted level of salbutamol.
This is where it can be rather difficult. Froome said he was not guilty of doing anything wrong and he could not understand why on that day he exceeded the allowed level. Froome was now given the chance to prove his innocence, and not for the ‘accusers’ to prove his guilt.
Past suspensions for the same infraction
As we know, there have been athletes who have been suspended in the past for exceeding the allowed levels, and this has also added fuel to the fire.
Riders have been banned in the past for returning an AAF for salbutamol. The most recent is Italian rider Diego Ulissi, who returned an AAF for 1900ng/ml of salbutamol during the 2014 Giro d’Italia. He was suspended from competition for nine months.
Among other cases, Alessandro Petacchi was suspended for a year and had five stage wins removed after returning an AAF for salbutamol at the 2007 Giro d’Italia.
Alexandre Pliuschin, a Moldovan rider for Team Synergy Baku in 2014. Details are not available for the level of salbutamol he recorded, but he was suspended for six months.
There have also been other riders who have had their cases acquitted due to medical reasons, and were not served a sanction.
What was needed to prove Froome’s innocence
Froome and Team Sky, were given the opportunity to conduct a controlled pharmacokinetic study (CPKS).
WADA rules state: “The presence in urine of salbutamol in excess of 1000ng/ml or formoterol in excess of 40ng/ml is presumed not to be an intended therapeutic use of the substance and will be considered as an Adverse Analytical Finding (AAF) unless the Athlete proves, through a controlled pharmacokinetic study, that the abnormal result was the consequence of the use of the therapeutic dose (by inhalation) up to the maximum dose indicated above.”
What must be noted, is that Froome was tested 21 times in total at the Vuelta and for some reason the reading was higher on this particular day. To achieve the same reading in a controlled lab situation, would be most difficult to replicate, due to the extremities involved in a tour scenario compared to a controlled environment.
People are quick to point out that there are different rules for others (to those who had been suspended in the past) and Team Sky. It must be mentioned, they would have been given the same opportunity but in the end chose to take the suspension. Fortunately, Team Sky chose to defend their athlete.
Froome had a tremendous amount to lose and had always expressed his innocence. Froome and Team Sky insisted that he only took the drug within legal limits.
According to Team Sky, Froome’s urine sample collected on September 7, 2017 was 19 per cent over the decision limit once dehydration was taken into account.
This study comes after a recent revision to Froome’s AAF. Under new WADA rules, a compensation has been made for urine concentration and dehydration, under which Froome’s level has been lowered to 1,429ng/ml rather than 2,000ng/ml. This was still above the 1,000ng/ml limit, though.
Chris Froome’s positive test for excessive levels of the asthma drug Salbutamol at this year’s Vuelta a Espana was unusual but dehydration or metabolism could have played a part, an anti-doping expert said
“Trying to recreate it exactly is going to be very difficult because he’d have been dehydrated at the end of that day as well as cumulative effects such as two weeks of cycling and so on. But that’s the next step, to do that study.”
In April 2018, a research paper was published by the British Journal of Clinical Pharmacology, it is considered that this was utilised as part of Froome’s defence – that Wada’s test for salbutamol is unreliable and needs to be overhauled.
Other information put forward, was that Froome could have suffered a temporary kidney malfunction.
The scientists are aiming to show that rather than excreting the metabolites of salbutamol after it had been processed by his liver, Froome’s kidneys malfunctioned and accumulated them. When his kidneys began to function properly again, they excreted it in the high levels that resulted in the extremely elevated test reading on 7 September.
This could explain the high reading. This is a possibility and it has been known to occur.
WADA announce fair outcome to complex case
During this whole process, the following was placed behind the Froome test of Vuelta *asterisk of pending resolution. Days before the Tour De France 2018 started, this was changed, and the *asterisk was deleted.
The UCI provided a press statement and the matter was referred to WADA who published the following:
WADA’s decision follows a full and careful review of all explanations and supporting evidence submitted by Mr. Froome in the month of June (which the UCI shared with WADA), as well as thorough consultation with internal and independent external experts. On the basis of this, WADA’s position is as follows:
(this has been shortened to present the most important)
Therefore, having carefully reviewed Mr. Froome’s explanations and taking into account the unique circumstances of his case, WADA accepts that:
the sample result is not inconsistent with an ingestion of Salbutamol within the permitted maximum inhaled dose; an adequate CPKS is not practicable; and the sample may be considered not to be an AAF.
This was the outcome and yet the public do not accept this as fair.
Looking further into the case, and the outcome, a few glaring pointers have come to the fore, and I shall attempt to present them accordingly.
Why was salbutamol on the banned substance list
The question has been asked as to why salbutamol is on the banned substance list.
Now herein, unfolds a history of suspicion and lack of understanding regarding salbutamol and asthmatic athletes, which the Froome case has exposed. This has not been put forward to the public and would explain why the Froome case is closed and the files are not available.
In order to get to where we are now, I need to go back a little in history and how come salbutamol came to be placed on the banned list originally.
At various Olympic Games in the past, it was found that many elite athletes have asthma.
At the Los Angeles Olympic Games in 1984, 41 of more than 67 athletes with proven exercise induced asthma (EIA) won medals in a wide range of sports including swimming, track events, rowing, and basket ball. More recently, Weiler et al studied the prevalence of asthma among American participants in the 1996 Olympic Games in Atlanta. Of the 699 athletes who completed the questionnaire, 107 (15.3%) reported a diagnosis of asthma, 97 (13.9%) had used an asthma medication at some time in the past, and 73 (10.4%) were using an asthma medication during the Games. Whether the prevalence of asthma is higher in athletes than in the general population remains controversial.
This lead to the belief that these asthmatic athletes must have been gaining an advantage from their asthma pumps. Even athletes who did not have asthma began to believe that the pump was a reason for asthmatic athletes gaining an advantage.
Salbutamol is provided via the asthma pumps – Salbutamol, also known as albuterol and is marketed as Ventolin among other names, it is a medication that opens up the medium and large airways in the lungs.
Before January 2004, the International Olympic Committee (IOC) was responsible for establishing the anti-doping rules on behalf of the international sport movement. WADA took over from the IOC. As more and more data debunked the idea that asthma inhalers have performance-enhancing capabilities, changes were made such as the removal of salbutamol from the banned substance list but was instead listed as a Beta-2 Agonist.
The upper limit for usage of salbutamol
Now that we (hopefully) established that salbutamol is not actually a banned substance (in the old sense of the wording) and that the Froome case is related to the AAF, we can look at the upper limit for usage, and how this was established.
Well, it never was, (from my understanding) it was taken directly from the manufacturers clinical guideline, and it is not related to performance enhancing or specific to anti-doping research. It could be said, that it is directly related to the manufacturer being liable for the misuse of their product. Their recommendation is related to the safe use of their product, and that if you need to take a higher dosage than prescribed, then you should do so at a hospital.
This in itself could be challenged, and may have been challenged by Froome and Team Sky.
What must also be noted is studies had previously been conducted about the performance enhancing effects of systemic beta2-agonists and Team Sky’s studies only added to this
Pluim et al (2011) literature concerning possible performance enhancing effects of systemic beta2-agonists is weak and calls for future studies with the use of more reliable, valid and sensitive performance protocols.
Pluim et al (2011) showed that the training level of the participants in the salbutamol studies have been low to moderate, which is not representative for elite athletes
Studies that have demonstrated anabolic effects of salbutamol have been done with animals, not humans, so it is highly likely that there is no identifiable quantity of salbutamol that would indicate a performance benefit.
WADA clears Froome before Tour De France
Many people were critical of how WADA, cleared Froome just in time to participate in Tour De France 2018. To everyone this was a convenient move by UCI and WADA which was seen as favouritism towards Team Sky.
The UCI statement revealed that, after months of research, Froome’s lawyers had submitted their explanation for his AAF on June 4 “together with significant additional expert evidence”.
It added: “The UCI has considered all the relevant evidence in detail (in consultation with its own experts and experts from Wada).
“On 28 June 2018, Wada informed the UCI that it would accept, based on the specific facts of the case, that Mr Froome’s sample results do not constitute an AAF. In light of Wada’s unparalleled access to information and authorship of the salbutamol regime, the UCI has decided, based on Wada’s position, to close the proceedings against Mr Froome.
To many people this may all seem very convenient, however, it would be good to know the following:
On 15 June, the National Assembly of Quebec approved Private Bill 238, which confirms that decisions taken by the World Anti-Doping Agency (WADA) are immune from civil litigation proceedings.
Wow, quite incredible this was pushed through and then Froome was cleared to race the Tour De France 2018.
A certain Professor Fitch also stated: that there should be doubt over previous cases involving salbutamol, such as that of Italian sprinter Alessandro Petacchi who served a one-year ban following a test at the 2007 Giro d’Italia.
“Petacchi was innocent,” Fitch continued. “They [Wada] have to accept that the rules need changing”
With this all said, I would like to express my full support of what WADA do, but it must be realised, that mistakes are possible. If we are all to truly benefit, they need to question certain aspects and attitudes towards asthmatic athletes which in a way labels them as potential cheats.
My interest in athletes with asthma over the years
On 26th February 2001, our son was born. Unfortunately, he experienced a bad start, whereby the umbilical cord had wrapped itself around his neck which led to him being born in oxygen debt. He failed the Agpar score
The Apgar score is a simple assessment of how a baby is doing at birth, which helps determine whether your newborn is ready to meet the world without additional medical assistance. Your practitioner will do this quick evaluation one minute and five minutes after your baby is born
We were told that we needed to return over time to check his development and specifically if there had been any damage to his brain. He was cleared of this however he was left being diagnosed as being asthmatic.
(He no longer falls into the asthmatic area but does still have a pump to assist him when needed)
Instead of looking at asthma as an affliction, I looked to embrace it as a gift and over the years, I developed a particular interest in athletes who have asthma and their performances. I have considered that an asthmatic person has to live in slight oxygen debt throughout their life, and therefore they have to develop in way that makes the most of every breath and indeed makes them unique, and if they train at a sport, they are likely to become rather good considering what they have had to endure to get there, especially if their asthma is controlled.
The mental strength gained and needed to achieve as an athlete with asthma should not be underestimated.
A few top athletes suffering from asthma
If you looking for two names who are asthmatic, former men’s world marathon record holder, Haile Gebrselassie of Ethiopia and current women’s world marathon record holder Paula Radcliffe of Britain. Coincidence, I think not 🙂
On a personal level, I have always considered asthma to develop an aspect where the individual would develop a more efficient functioning capacity due to the hindrance caused by asthma, very similar to someone born, living and training at altitude. Froome not only has asthma but was born in Nairobi, Kenya and from 14 years of age was living in Johannesburg, South Africa, where he still returns to, to do his ‘base’ training every year.
Fatalities due to an asthma attack
An asthma attack occurs when the airways of the lung become narrowed causing an obstruction to the flow of air. Symptoms include coughing, wheezing, breathlessness and a tightness in the chest. People die on a daily basis due to an asthma attack.
I have mentioned this to underline the seriousness of asthma and to hopefully provide support to those people who have risen above their setback to become an elite athlete.
There will unfortunately be naysayers, who simply want to prove Froome is a cheat and will say that he is guilty purely by being connected to Team Sky. The cycling world has changed a tremendous amount in the last 5 years and so to has the testing of athletes. The fight is real and major inroads have been made in how they are working to keep the sport clean and the ‘biological passport’ is one of the biggest factors that will help in the long-term combating against doping.
Hopefully this article has been interesting and a little helpful in understanding the Chris Froome salbutamol case
The Demonising of Chris Froome is an opinion ‘piece’ and may contain flaws, its intention is to assist in understanding the complexities involved in the Chris Froome case.