Team Sky rival’s medic says TUE claims of Bradley Wiggins doctor are ‘flimsy’
An experienced team doctor has said the claims that British Cycling and the former Team Sky medic Richard Freeman needed a large supply of the corticosteroid triamcinolone to treat staff and riders are “flimsy”.
Dr Prentice Steffen of the rival Cannondale-Drapac squad, who has worked in cycling for a quarter of a century, said he could recall using the drug only three times in a 10-year period.
British Cycling plots a more corporate, less maverick route out of troubleWilliam Fotheringham
Read more“I think this has to be looked at with the greater context in view – the three suspicious TUEs that Brad Wiggins was granted just before the three Grand Tours,” Steffen told the Guardian. “If they had more than one dose [available], within the context of what they gave Brad for his pollen allergy, I think it’s a bit flimsy.”
AdvertisementThe therapeutic use exemptions (TUEs) granted to Wiggins for the use of triamcinolone before the Tour de France in 2011 and 2012, and the Giro d’Italia in 2013, were done within International Cycling Union rules after the presentation of a specialist’s letter specifying clinical need to treat his pollen allergies. There is no suggestion Wiggins took more than these doses.
On Wednesday the UK Anti-Doping chief executive, Nicole Sapstead, told MPs Freeman had placed orders for amounts of triamcinolone that were “far more” than needed for Wiggins’s three pollen allergy treatments. Sapstead did not specify the quantity but stated: “You would think there was an excessive amount of triamcinolone being ordered for one person, or quite a few people had a very similar problem.”
Team Sky confirmed to the website cyclingnews.com on Friday that, as part of the staff medical service, Freeman treated some members with triamcinolone, while a report on Thursday evening claimed Freeman might have treated, “not just riders but staff, family and friends”.
A precise like-for-like comparison between the two doctors’ needs is hard to draw because the picture of how many potential patients would be on Freeman’s books is hard to establish: along with the GB cycling team riders and staff, mainly based in Manchester, Team Sky number roughly 100 people, but many of those are based abroad.
AdvertisementSteffen said that his team, Cannondale, he would have a smaller pool of potential patients, “roughly 30 on the road at a given race, multiplied by 250 race days per year. We don’t have someone based in Girona, Spain, so we wouldn’t be available to all 85 or so team employees who come and go through our Service Course. We’d send them to a local clinic that we have an arrangement with. "That said, I don’t recall ever sending anyone there and them getting a cortico injection.”
“What is reasonable to me and our practice is to have one dose [40 milligrams] available for a serious situation,” Steffen told the Guardian. He added that he “could see no justification” for having more than that single dose available for immediate use, while Cannondale’s use of triamcinolone to treat riders and staff was so infrequent they were contemplating not carrying any of the drug at all.
He added that in his 10 years at the team he recalled only three occasions on which triamcinolone had been administered: to a soigneur for an elbow problem, a mechanic with a shoulder issue and a rider with tendinitis in a wrist. To the best of his recollection, he said, he had never given it for a pollen allergy.
British Cycling will overhaul link with Team Sky after ‘shocking’ revelations
Read more“We use it strictly for tendinitis; we gave the rider a couple of injections, reported it to the UCI and kept him out of competition,. You might use it for a severe allergic reaction such as a bee sting, with the caveat that you would need an emergency TUE if you were at a race or you would need to be out of competition, but I’ve not even had that in 25 years,” he said. Steffen’s views were backed up by a second experienced sports doctor to whom the Guardian spoke but who did not wish his name to be disclosed.
He said that in his view “not many cycling injuries” needed treating with triamcinolone and suggested that Dr Freeman might potentially require four or five doses a year for his patient population of BC and Sky riders and staff at the Manchester velodrome. However, he added that if injured riders were treated off site after a scan they might well receive a steroid injection in the clinic providing the service. That might slightly reduce the need to retain a supply of triamcinolone at the velodrome.
British Cycling's former performance director Sir Dave Brailsford has admitted he was given an intra-articular injection to reduce inflammation in his knee.
He told the Daily Telegraph: "On one occasion a clinical decision was made to treat the symptoms within the joint with an intra-articular corticosteroid injection. This was done with the appropriate assessment, informed consent and subsequent monitoring. The treatment was administered to me by our then team doctor, Dr Freeman."
Source: https://www.theguardian.com/sport/2017/mar/03/cycling-tue-bradley-wiggins-richard-freeman
Dr Prentice Steffen of the rival Cannondale-Drapac squad, who has worked in cycling for a quarter of a century, said he could recall using the drug only three times in a 10-year period.
British Cycling plots a more corporate, less maverick route out of troubleWilliam Fotheringham
Read more“I think this has to be looked at with the greater context in view – the three suspicious TUEs that Brad Wiggins was granted just before the three Grand Tours,” Steffen told the Guardian. “If they had more than one dose [available], within the context of what they gave Brad for his pollen allergy, I think it’s a bit flimsy.”
AdvertisementThe therapeutic use exemptions (TUEs) granted to Wiggins for the use of triamcinolone before the Tour de France in 2011 and 2012, and the Giro d’Italia in 2013, were done within International Cycling Union rules after the presentation of a specialist’s letter specifying clinical need to treat his pollen allergies. There is no suggestion Wiggins took more than these doses.
On Wednesday the UK Anti-Doping chief executive, Nicole Sapstead, told MPs Freeman had placed orders for amounts of triamcinolone that were “far more” than needed for Wiggins’s three pollen allergy treatments. Sapstead did not specify the quantity but stated: “You would think there was an excessive amount of triamcinolone being ordered for one person, or quite a few people had a very similar problem.”
Team Sky confirmed to the website cyclingnews.com on Friday that, as part of the staff medical service, Freeman treated some members with triamcinolone, while a report on Thursday evening claimed Freeman might have treated, “not just riders but staff, family and friends”.
A precise like-for-like comparison between the two doctors’ needs is hard to draw because the picture of how many potential patients would be on Freeman’s books is hard to establish: along with the GB cycling team riders and staff, mainly based in Manchester, Team Sky number roughly 100 people, but many of those are based abroad.
AdvertisementSteffen said that his team, Cannondale, he would have a smaller pool of potential patients, “roughly 30 on the road at a given race, multiplied by 250 race days per year. We don’t have someone based in Girona, Spain, so we wouldn’t be available to all 85 or so team employees who come and go through our Service Course. We’d send them to a local clinic that we have an arrangement with. "That said, I don’t recall ever sending anyone there and them getting a cortico injection.”
“What is reasonable to me and our practice is to have one dose [40 milligrams] available for a serious situation,” Steffen told the Guardian. He added that he “could see no justification” for having more than that single dose available for immediate use, while Cannondale’s use of triamcinolone to treat riders and staff was so infrequent they were contemplating not carrying any of the drug at all.
He added that in his 10 years at the team he recalled only three occasions on which triamcinolone had been administered: to a soigneur for an elbow problem, a mechanic with a shoulder issue and a rider with tendinitis in a wrist. To the best of his recollection, he said, he had never given it for a pollen allergy.
British Cycling will overhaul link with Team Sky after ‘shocking’ revelations
Read more“We use it strictly for tendinitis; we gave the rider a couple of injections, reported it to the UCI and kept him out of competition,. You might use it for a severe allergic reaction such as a bee sting, with the caveat that you would need an emergency TUE if you were at a race or you would need to be out of competition, but I’ve not even had that in 25 years,” he said. Steffen’s views were backed up by a second experienced sports doctor to whom the Guardian spoke but who did not wish his name to be disclosed.
He said that in his view “not many cycling injuries” needed treating with triamcinolone and suggested that Dr Freeman might potentially require four or five doses a year for his patient population of BC and Sky riders and staff at the Manchester velodrome. However, he added that if injured riders were treated off site after a scan they might well receive a steroid injection in the clinic providing the service. That might slightly reduce the need to retain a supply of triamcinolone at the velodrome.
British Cycling's former performance director Sir Dave Brailsford has admitted he was given an intra-articular injection to reduce inflammation in his knee.
He told the Daily Telegraph: "On one occasion a clinical decision was made to treat the symptoms within the joint with an intra-articular corticosteroid injection. This was done with the appropriate assessment, informed consent and subsequent monitoring. The treatment was administered to me by our then team doctor, Dr Freeman."
Source: https://www.theguardian.com/sport/2017/mar/03/cycling-tue-bradley-wiggins-richard-freeman