Therapeutic Use Exemptions (TUEs) are essential in sport: but there is room for improvement

Hacking of the World Anti-Doping Agency’s (WADA’s) Anti-Doping Administrative & Management System (ADAMS) by an alleged Russian cyber espionage group ‘Fancy Bear’ disclosed incomplete information about Therapeutic Use Exemptions (TUEs) granted to more than 100 Olympic athletes from over 20 countries1 including some high-profile athletes. These unethical and illegal leaks of personal medical information provoked some criticism of the TUE system, much of it is ill-informed.2 3 In this discussion, I briefly review the concept of TUEs and advise how the TUE system can and should be strengthened. The TUE concept is both sound and essential, and the four criteria that must be met to approve a TUE have changed only marginally in 25 years4 (online appendix 1a). ### Supplementary data [bjsports-2018-100113supp001.docx] After WADA approved the TUE guidelines in 2004 (that the IOC had adopted in 1991), WADA developed TUE Physician Guidelines —a valuable resource that currently outlines 19 of the different medical conditions that may necessitate an application for a TUE.5 These are updated regularly. TUEs are required to be uploaded …