Zero tolerance to doping in trail ultramarathon
…plus zero tolerance to anyone with a medical condition
The Ultra-Trail du Mont-Blanc (UTMB) announced last year that they would be extending their medical and anti-doping policy to all races in the UTMB World Series 2022. Their goal is “protecting athletes from the dangers of self-medicating”, according to the medical director, Dr Patrick Basset.
I have been concerned about this since I saw and shared the below announcement on Facebook in September — not about the banning of painkillers so much as the banning of many drugs considered acceptable for therapeutic use exemptions under the World Anti-Doping Agency (WADA) and considered necessary by the doctors who prescribe them.
If you follow me on Facebook, you may recall I posted concerns about implications for those with asthma. I sought others’ feedback because I didn’t have time to look into it myself. My friends were quick to mention several autoimmune and thyroid conditions that could be impacted, and antidepressants and iron infusions also ended up on their banned list, along with the beta-2 agonists that are probably best known for their use as asthma relieving drugs.
According to the rules document, the QUARTZ Event Program that will apply at UTMB World Series events is intended to “protect participants’ health and to contribute to a truly clean sport.”
I think Annabel Hepworth better described it as “textbook mission creep”.
In many cases, the drugs are not banned at all times, but for a certain window before races. In some cases, this at least seems well-intentioned: if you require an iron transfusion for anaemia — a condition that’s far more likely to affect women than men — perhaps a trail ultramarathon is not the best thing for your health right now. But is it necessarily worse for your health than opting to skip the infusion, taking supplements instead, and going ahead with the race? Who decided that? Who chose the arbitrary 60-day window on this? Who does this protect?
Another concerning example is the runner with a history of asthma that’s well controlled with inhaled corticosteroids: for seven days before your race and during your race, you must give up those drugs and just hope your asthma doesn’t flare up, because you also can’t take your reliever during the race.
As far as QUARTZ Program director Dr Pierre Sallet is concerned, athletes with medical conditions should not receive an exemption for therapeutic use because “if the athlete has an illness, he or she should stay at home until healthy.” Dr Sallet is a physiologist and at this point I’d question his understanding of pathology, because “healthy” is a complex idea and many health conditions will never go away but are more than adequately controlled with ongoing medication.
This has brought back for me a widely published quote from Jason Shortis, an elite long-course racer who was diagnosed with asthma mid-career: “I thought it was normal to feel short of breath but since being on the puffer I can’t believe how much air is out there.” The WADA specifically provides therapeutic use exemptions where indicated, so that athletes who live with medical conditions can participate safely and achieve their potential.
The QUARTZ Program is not about making the sport clean or healthy. It makes athletes choose between their health and their sport, and tells us that elite sport is only for those without medical conditions.
As more and more directors of iconic trail races proudly announced they’d joined the UTMB World Series, I grew concerned about whether these QUARTZ Event Program rules would apply. (Note that some race websites still refer to the old Ultra-Trail World Tour or UTWT.)
The Western States Endurance Run (WSER) was first on my mind, as it is a race with a long history and a very Californian race vibe — it’s friendly and welcoming and has made an effort to help people into the sport. It’s one of the first races to have an explicit policy for transgender inclusion. Preventing participation by athletes requiring medication seemed out of character.
The website still refers to the UTWT so I am not sure how up-to-date it is, but I was impressed that they seem to be enforcing the QUARTZ Event Program rules only for athletes entering through six reserved UTWT spots:
Runners who gain entry into WSER through UTWT must agree to participate in the QUARTZ Event Program, a health and anti-doping program managed and administered by Athletes For Transparency Association (AFT). WSER has no affiliation with, or control over, the Quartz Event Program, other than agreeing to require its UTWT entrants to participate.
So it seems like everyone else can just enter and respect the WADA regulations, the way it’s always been. Interestingly, the WSER version of the rules document also omits the first sentence about how the program protects health and contributes to clean sport. I like to image they’ve done this to acknowledge that banning life-saving drugs really doesn’t protect anyone.
I also checked out Ultra-Trail Australia (UTA), because it’s my “local” race in the UTMB series. The information wasn’t so easy to find: I went to the Entry Overview page and scrolled down to Race Rules. The UTA 50, 22 and 11 race rules documents make no reference to QUARTZ, only to WADA and the Australian Sports Anti-Doping Authority (ASADA).
However, the UTA 100 rules state:
2. Performance enhancing drugs are prohibited in accordance with The World Anti-Doping Code and the QUARTZ Event Program. Refer to the list of prohibited substances and methods under the Australian Sports Anti-Doping Authority.
Note also that the link from the UTA 100 rules document points to a 2019 version of the QUARTZ Event Program, which focuses on glucocorticoids, whereas the main Entry Overview page link points to the 2021 version, which adds specific references to iron infusions, other infusions, gas inhalations, beta-2 agonists, painkillers, thyroid hormones and drugs in the WADA monitoring program.
The way I read this, the QUARTZ Event Program rules apply to all participants in the UTA 100.
I’m not the first person who has written about this and I really, really hope I’m not the last. Here is a fantastic twitter thread on the subject, written back in September by ultramarathon coach Jason Koop, and I’d encourage you to click through and read it:
Zero tolerance to doping is an excellent goal in sport, and it’s why WADA and ASADA exist. It’s also very different from zero tolerance to prescribed medication use in sport, which means zero tolerance to athletes with otherwise well-managed medical conditions and zero tolerance to informed medical opinion.
If you’re an athlete with a medical condition who has signed up for a UTMB World Series race unaware of the “health” program in place, you might want to consider how you feel about this information.
And if you’re an athlete who cares about discrimination against people with medical conditions, you might want to consider this also.
