SII Focus 30th March 2017

Despite Dr. Freeman’s evidence, questions remain about Wiggins package

Despite written evidence given by Dr. Richard Freeman to the Culture, Media and Sport (CMS) Committee of the UK Parliament on 28 March, a number of questions remain about a jiffy bag delivered by women’s road coach Simon Cope to Dr. Freeman, which he administered to Bradley Wiggins at the end of the 2011 Critérium du Dauphiné in France. The most pressing of these is  why it was necessary to send a women’s road coach to deliver fluimucil to Dr. Freeman at huge cost to lottery-funded British Cycling, when he had previously bought his preferred form of fluimucil from a pharmacy in Switzerland just two months earlier.

Medical records

Dr. Freeman has confirmed that although he and Dr. Steve Peters routinely kept medical records relating to cyclists at British Cycling and Team Sky on their laptops, only a paper-based system was in place in 2011 and neither British Cycling nor Team Sky had a written medicines management policy or stock-taking system. The admission was part of two pieces of written evidence (PDFs below) submitted to the UK Parliament’s Culture, Media and Sport (CMS) Committee’s inquiry into Doping in Sport, which has been investigating the contents of a jiffy bag delivered by women’s road coach Simon Cope to Dr. Freeman, which he administered to Wiggins at the end of the 2011 Critérium du Dauphiné in France.

‘Once again, this new evidence leaves major questions outstanding for Team Sky and British Cycling’, read a statement from Damian Collins MP, who Chairs the CMS Committee. ‘In particular, why were no back up medical records kept for Bradley Wiggins in 2011, beyond those on Dr Freeman’s laptop computer? Why were there not more formal protocols enforced on recording keeping, and whose responsibility was it to make sure that Team Sky’s own stated policies were being enforced?’

In his written evidence, Freeman confirmed that he ‘inherited a paper-based system’ of medical record keeping at British Cycling, and that as a result of a team support member’s death during the 2010 Vuelta a España, a DropBox system was adapted to allow medical information to be shared as a ‘better’ system of record keeping. However Dr. Freeman did not routinely upload his notes to the DropBox system, which he ‘found difficult to use, having ongoing concerns about its security and greater confidence in my own system of note keeping’. He notes that the DropBox system was ‘never meant to replace individual doctors’ medical records’, but accepted that ‘it would have been desirable to have backed up my clinical records, whatever system was used’. He adds ‘I regret not doing this’.

‘In 2011 neither team had a written medicine management policy or stock taking system’, reads Dr. Freeman’s evidence. ‘In 2011, both prescription and over the counter medicines were ordered in bulk then dispensed to individual patients and this process recorded in their medical records’. Therefore as Dr. Freeman had not been backing up his medical records or uploading them to the DropBox system, the only record of medications administered to Wiggins during 2011 was on his laptop.

Unfortunately, it appears that Dr. Freeman’s laptop was stolen whilst he was on holiday in Greece during the summer of 2014. UK Anti-Doping (UKAD) has previously confirmed there is a record that Dr. Freeman’s laptop was reported to British Cycling as stolen, and it is currently working with Interpol to verify that the theft was also reported to the police. As the only copy of Wiggins’s medical records from 2011 were on the stolen laptop, it would appear that they have been lost.

It also appears that Wiggins has not given Dr. Freeman permission to discuss any medical treatments administered to him. In evidence given to the CMS Committee on 19 December last year, British Cycling’s former Technical Director Shane Sutton said Dr. Freeman had told him “Brad’s been sorted”. When questioned about this, Dr. Freeman’s written reply was as follows: ‘As you will appreciate from my previous correspondence – I am unable to talk about any patient issues without the express consent of the patient, and this has not been given as far as I understand’.

What was in the jiffy bag?

There has been much speculation about what was in the jiffy bag that women’s road coach Simon Cope delivered to Dr. Freeman at a cost of £1,263.90 to British Cycling, without asking what was in it despite having to take it through airport security. UKAD initially launched its investigation into British Cycling and Team Sky on 23 September 2016 after receiving “additional information” that the package contained triamcinolone.

The UKAD investigation began after the hacking group Fancy Bears leaked documents purporting to indicate three therapeutic use exemptions (TUEs) held by Wiggins for triamcinolone. As it is a glucocorticoid, triamcinolone’s use is prohibited in competition (IC) via ‘oral, intravenous, intramuscular or rectal routes’, however its use is permitted via other routes and out of competition (OOC).

Dr. Freeman, British Cycling and Team Sky have consistently argued that the only thing in the package was a decongestant medicine, fluimucil. The Sports Integrity Initiative has previously reported that fluimucil was not licensed for use in the UK and is not recommended for sufferers of asthma, such as Wiggins. The NHS reference page indicating that fluimucil is not licensed in the UK has since been taken down, but fortunately there is another one.

Fluimucil is available in France, where the Critérium takes place, and in Italy, where Wiggins and Team Sky were heading for a training camp in Sestriere after the Critérium had finished. There are five pharmacies within 10 kilometres of Sestriere.

Team Sky has already explained that the particular form of fluimucil used by Dr. Freeman was not available in France, but that it had previously been ordered from a pharmacy in Switzerland by Dr. Freeman in April 2011. The Sports Integrity Initiative has previously pointed out that the pharmacy in Yverdon, Switzerland, is about 250km by road from La Toussuire, where the Criterium finished and less than 350km by road from Sestriere, Italy.

‘During the Dauphiné in June 2011, we were running low on fluimucil […] my first thought was of the supply I had in Manchester, and that the team would be able to access that supply quickly’, reads Dr. Freeman’s evidence. ‘It did not occur to me to travel to Switzerland. Only fluimucil was contained in the package sent.’ However, this answer avoids the possibility of couriering the particular form of fluimucil from the Swiss pharmacy to either Italy or France, or sending an employee to collect the drug.

‘It is important to note in 2011 that fluimucil was only provided by one overseas supplier (mainly), and obtaining further supplies from them whilst on tour was very impractical, particularly when we had stock remaining in store’, reads Dr. Freeman’s evidence. However, as previously stated, Dr. Freeman had previously ordered fluimucil from a pharmacy in Switzerland two months before the Dauphiné.

Other substances used by British Cycling & Team Sky

As previously mentioned, UKAD commenced its investigation into British Cycling and Team Sky after receiving information that the jiffy bag contained triamcinolone. ‘I have only ever personally administered triamcinolone to one rider at Team Sky and British Cycling’, reads Dr. Freeman’s evidence. ‘Tramadol [opioid used in pain relief] has always been used infrequently in Team Sky and only ever according to clinical need’.

Improvements to policies

Dr. Freeman also outlined a number of improvements that have been made to procedures at British Cycling and Team Sky, including a Medicines Management Policy. ‘Many of these are obvious and have happened with evolution, some as the direct response to the UKAD investigation’, reads his evidence. The improvements include:

• Stock control review of medicines ordered for British Cycling (introduced by Dr. Freeman and Dr. Peters in early 2012);
• Any medicine taken abroad must be stock controlled, and ordered from suppliers holding Wholesale Distribution Authorisation;
• No stocks of medicine kept for personal dispensing at the Manchester Velodrome, where only prescription medication to deal with life-threatening emergencies will be kept;
• Electronic, secure, backed up medical records system.

Questions remain

As we still have no evidence regarding Bradley Wiggins’s medical records relating to 2011, and it appears that Wiggins has not given consent for his medical treatments to be discussed, speculation will unfortunately continue about whether the jiffy bag did contain only fluimucil, or something more. Although British Cycling, Team Sky and Dr. Freeman have clarified that they only used a particular form of fluimucil ordered from an overseas supplier, they have not clarified who that overseas supplier was and why it was necessary to spend £1,263.90 so that a women’s road coach (Simon Cope) could deliver it to Dr. Freeman.

Although it may have been problematic to get the overseas supplier to send the fluimucil to Dr. Freeman, questions remain as to why he did not simply courier his preferred form of fluimucil from the pharmacy in Switzerland, where he had bought it two months earlier. Dr. Freeman’s answer that he did not consider travelling to Switzerland to collect the fluimucil appears to avoid solutions to that problem. The question about fluimucil’s apparent unsuitability for sufferers of asthma – such as Wiggins – has yet to be answered.

Also, as previously reported, UKAD only release the results of its investigations where an anti-doping rule violation (ADRV) has been found to have occurred. Fluimucil and its active ingredients do not feature on the World Anti-Doping Agency’s (WADA) Prohibited List. So, ironically, if it was only fluimucil in the jiffy bag, then we are not likely to find out.

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