Velobs

Can a medicine of performance be credible ?

The starting point for this debate is Gérard Guillaume, who is putting his foot in his mouth. His requirement is quite radical : no profit sharing, no performance bonuses. Doctor of FDJ.fr team, referring doctor of MPCC, he exposes his views with conviction : he believes that only the health control of the riders should concern him and that participate in the optimization of the training is incompatible with medical ethics. A point of view on which we have been collecting his colleagues' feedback (see below). So, what do YOU think ?

The interview with Gérard Guillaume, FDJ.fr doctor :

Prentice Steffen, doctor of team Garmin-Sharp, tempered Gérard Guillaume’s position while emphasizing the importance of trust, which must be consolidated with a doctor who has an expertise in physiology. Nevertheless, he joined Gérard Guillaume on the question of performance bonuses, which are also expressly prohibited by the UCI regulations.

The interview with Prentice Steffen, Garmin-Sharp doctor : 

According to Eric Bouvat, doctor of the team AG2R La Mondiale, a physician with expertise in training may be more effective in this field because he will think of the health prevention. He considers the the problem arises when you have the two functions.

The interview with Eric Bouvat, AG2R La Mondiale doctor :

The transcript of the interview :

"According to our curriculum and our expertise, we visit our patients, because they are our patients, for me they are all patients even if they are athletes, we visit our patients to express our skills. I am not a specialist in dermatology, so when I have a problem, I call a friend who is a dermatologist. So I don’t get why, because you're a doctor, you could not participate in training. That's it. Nevertheless, make the two becomes problematic. Can we be the doctor of the athletes and both their coach. It is a matter of debate. It is not as clear-cut as that, if the doctor respects the rule of 100% of the capacity of people, he surely may be effective in training and maybe even more effective because he will think of health prevention in the quantity of training he is going to propose. And regarding the injury prevention, he’ll be even more likely to prevent injury than a coach could be."

Reflection of Anko Boelens, the Dutch team doctor of Giant-Shimano, focuses on the difficulty of defining what we really mean by medicine of performance. He takes the example of paracetamol, which treats the pain and discomfort, but might be counted as a performance drug if it's taken "just in case". 

The interview with Anko Boelens, Giant-Shimano doctor :

"Performance medication is a very grey area. Where does it start, where does it end ? Sometimes it is easy : for instance EPO is always a performance medicine, and should therefore always be banned. But what for instance about a paracetamol ? Riders will feel discomfort during races, so they might take two paracetamol during the race. Is this performance medicine ? I think medication that serves only one purpose - to make a rider go faster - can be called a performance medicine.

In the example I gave before, paracetamol would not be called a performance medication because it counters pain and discomfort. However if they would always take it just in case, it might be called performance medication and riders who do such a thing should be discouraged to do so. On a more practical sidenote, medication that might have sight effects or when it is not known if there are side-effects, is in my opinion always a no-go. Tramadol is a very fine example. It might be responsible for more accidents during the race and can therefor not be tolerated.

And finally, I absolutely agree that the medical staff should never receive performance bonuses. As a doctor you are charged with two things : to make sure your riders stay in the best health possible, and that once they are sick or injured that get well. Making them go faster is not a direct goal, you try to make the team a better team trying your best to keep everyone fit. This I think can not be measured by the number of victories a team gets, so as a doctor you should not expect a bonus."

by Velobs

WADA bans xenon: this effectiveness satisfies MPCC

A request based on a large concern

During the last Olympic Winter Games in Sochi, the press revealed the presumed use of xenon gas by Russian athletes, in order to improve their performance. From March 6, MPCC had written to the President of the World Anti-Doping Agency Sir Craig Reedie, asking him to add this product to the list of prohibited methods. Xenon gas has nothing to do with the health of athletes, it is only a method used to get round regulations and is contrary to the philosophy of anti-doping. MPCC demand was mainly driven by a sense of concern about a dangerous practice.

In less than three months, WADA officially added the xenon gas to the banned list: this decision and the speed of execution of WADA fully meet MPCC's expectations, which now hopes the same awareness about the effects of tramadol in competition.

by Velobs

Tramadol : MPCC alerts WADA to riders’ health

WADA continues to observe and evaluate

During their last meeting in Montreal, the World Anti-Doping Agency (WADA) and its group of experts have examined the issue of integrating Tramadol in the list of banned drugs or not. The non-use of Tramadol in competition is a formal commitment of the teams' doctors MPCC at the General Assembly in October 2013. The conclusion of WADA is as follows: "Tramadol is maintained for the moment in the supervision program on the 2015 list of prohibited substances and methods. The experts group will conduct an overall evaluation of analgesics, narcotics and tramadol included, during the year." WADA adds that "recent discussions with experts of the pain management of athletes indicated that opiates or narcotics were more appropriate on a sports point of view, than other non-prohibited analgesics."

Gérard Guillaume: “It is irresponsible to give this medication to a cyclist in the context of the competition”

WADA believes that the use of tramadol affects cycling more than any other sport: "The latest data collected by the control group continue to indicate that Tramadol is used more in cycling than in any other sport." Referring physician with MPCC, Gérard Guillaume goes against this feeling: "Tramadol is used equally, if not more, in sports such as football, rugby sports where athletes receive shocks. But in these sports, Tramadol is administered as a pain-killer after matches. In cycling, the problem is that it is administered in competition, on stage races. With the sequence of races, Tramadol exposes the rider to health problems because of its side effects: drowsiness, dizziness. From a medical point of view, it is irresponsible to administer this medication to a cyclist in the context of the competition."

A common sense request, from a health point of view ; a response from a purely anti-doping perspective

MPCC does not require the prohibition of Tramadol out of competition but in competition. "All sports are not exposed to risks in the same way. Speed sports are hardly compatible with taking Tramadol in competition. We ask a question from a health point of view. The stake is health and safety of the riders, not anti-doping. And WADA replies us just from an anti-doping point of view. We address a common sense request. Any doctor knows it and sees it every day with his patients: Tramadol causes real side effects."

Read the letter of WADA

by Velobs

MPCC, a force of proposition recognized by UCI

"When the UCI and the PCC spend one hour debating on MPCC, saying “they agree with our philosophy and objectives", it does mean we go in the right direction."

The meeting of PCC last week has strengthened the links between the UCI and MPCC. What conclusions do you draw?

First of all, it was very important to introduce MPCC to all new members of the Professional Cycling Council (PCC) chaired by David Lappartient and UCI President Brian Cookson. MPCC today represents 75% of the World Tour and Pro Continental teams. That means 75% of runners, 75% of physicians, 75% of sponsors ... and also Continental and Women's teams, national federations, organizers. Obviously, this gives great importance to our work. MPCC has a large majority in professional cycling and embodies a true philosophy. Our movement continues to grow with the opening to the women's teams, which will be more numerous in the movement in the coming weeks. International bodies recognize MPCC. When the UCI and the PCC spend one hour debating on MPCC, saying “they agree with our philosophy and objectives", it does mean we go in the right direction.

How can we determine the exact role of MPCC with the UCI?

MPCC is an essential complement to the action of the UCI and WADA, we are on their side. In the past, major doping scandals that have shattered the sport in general, were not only triggered by the authorities, but also by external investigations. Legally, the UCI cannot do what they want to fight against doping. They must fully comply with the rules established by WADA. MPCC's basic principles are volunteering and personal commitment: this is a major trail that had not been exploited so far. It is in this sense that we are fully complementary to the actions of the UCI and WADA. We can take action they cannot lead. Authorities have their limits. For example, when the IOC had forbidden the participation of positive athletes at the London Olympic Games, the Arbitral Tribunal of Sport, whose all decisions are "right" under the law, had invalidated the decision. This has been the case in many other actions led by our leaders. Volunteering can override this: the manager, organizer, President of Federation, member of MPCC, has a decision-making power, the power of respecting the international rules, but also the rules issued together by MPCC.

"Now everybody knows how MPCC works, which stricter rules are observed by the members, how strong and significant their commitment is."

What will the consultation of the UCI with MPCC consist of ?

The UCI said: "What you do helps us, bravo! Volunteering is obviously an essential complement to our action". The UCI will examine the possibility of incorporating in its regulations MPCC rules that do not involve legal blockage. MPCC will make an annual report on its activity to PCC. At this meeting of the PCC, we realized that everyone agreed with the philosophy of MPCC. Everybody! The keystone remains voluntary participation and that is the reason why MPCC was created and grown up. Few teams already applied some of our rules before the creation of the movement, and now, they are 75% to get involved. This changes the game and become a key addition to the UCI and WADA. MPCC formally complete the anti-doping device desired by all.

And the strict compliance with the rules of MPCC is no stranger to the growing support of these authorities?

In 2013, following the massive wave of accessions recorded during the previous winter, the MPCC rules have all been applied by all members This has reinforced our efforts and this work is crowned by the recognition of the PCC and UCI. This year that has passed has validated the credibility of MPCC, to give a meaning to the renewal of credibility of cycling. Now everybody knows how MPCC works, which stricter rules are observed by the members, how strong and significant their commitment is.

by Velobs

MPCC expects actions from the French Ministry of Sports

MPCC wants to alert the French authorities to cortisol controls. To do so, MPCC has contacted the Sports Minister Valérie Fourneyron at the end of February, after initial discussions dating from 2013. A letter was sent on May, 13th, 2013 to raise awareness about the need to apply the rules of cortisol controls to all teams, members or non-members of MPCC, on every competition taking place in France. The French Ministry of Sports had answered on June, 27th 2013, but since then no decision was taken. That’s why MPCC returned to Mrs. Fourneyron to invite her to reconsider these proposals, which also include the prohibition of Tramadol in competition and the need to make a formal request to the World Anti-Doping Agency for this product to be written on the list of banned products.

"It would be logical to see all the teams taking part to a competition, being controlled in the same manner and medically monitored externally."

This letter was sent to the French Ministry of Sports on February, 25th. Since 2008, MPCC has performed blood tests to check cortisol levels of riders, whose teams are members of the movement, in collaboration with the French Cycling Federation and the National League of Cycling. It is a public health problem with occupational risks for employees of companies exercising regularly or temporarily on French territory : MPCC members are not pleased with the response that was made to them, feeling not being heard.

"In the context of health, we do think it is possible to integrate the parameter of cortisol in samples that you will make on the French territory”, writes MPCC in this letter. "It would be logical to see all the teams taking part to a competition, being controlled in the same manner and medically monitored externally." Now MPCC expects actions from the French Ministry of Sports in order to promote equity among teams and to participate in restoring credibility to cycling.

by Velobs