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The MLB TUE Could Be a PED, but Should Be an A-OK


Yesterday, the Congressional inquiry into doping in baseball paid attention to medical TUEs. A discussion centered on the TUE given to medications useful for the treatment of Attention Deficit Hyperactivity Disorder (ADHD). Therapeutic Use Exemptions (TUE) give athletes with medical diagnoses an exemption to use a drug normally prohibited by MLB, to treat a legitimately diagnosed medical condition.

The issue raised by the Waxman hearing concerned the dramatic increase in TUEs for ADHD among MLB players. Physicians treat ADHD with 'stimulants' (although I object to that label) including Ritalin (methylphenidate) and Adderall (a mixture of amphetamine salts). From the Minneapolis Star-Tribune:

Amid discussion of steroids and human growth hormone, amid an atmosphere more tame than tempestuous, it was Rep. John Tierney, D-Mass., who caught everyone's attention when he asked why the number of major leaguers claiming "therapeutic-use exemptions" for Attention Deficit Disorder had mushroomed to 103 this past season from 28 in 2006.

To Tierney, the implication was clear: Players were getting around the ban on amphetamines by making ADD claims that allowed them to use drugs such as Ritalin and Adderall, stimulants better known as treatments for hyperactive kids.

The National Institute of Mental Health estimates 3 to 5 percent of children have ADHD, according to its website.

According to the MLB data, 1,354 players were subject to testing last year. That means 8.2 percent received permission to use the stimulants.

"That would make that almost eight times the normal adult usage in our population," Tierney said.

How, Tierney wanted to know, had baseball allowed this to happen?

Relax a bit. The current TUE policy in MLB is relatively new. Eight percent of MLB players treated for ADHD does not set off alarm bells in my book. The increase could be due to a better understanding of the rule, and to a higher number of players seeking a deserved TUE.

If the physicians prescribing the medications make accurate diagnosis, and provide a reasonable dose of medication, this does not represent a way to 'cheat within the rules'.

A therapeutic dose of methylphenidate will benefit concentration, and may improve motor coordination slightly (unlike children with ADHD where motor incoordination can be significant, the improvement in motor coordination seen with stimulant treatment would be minimal in a professional athlete). Without treatment, players manifesting the symptoms of untreated ADHD would be at a disadvantage to non-ADHD players.

If an organization accepts the concept of medical disabilities due to a disease, then those disabilities should be treated. These exists a clear difference between athletes who take pharmaceutics to correct a medical problem such as poor vision, ADHD, or legitimate endocrine problems, versus those who abuse the treatments as a performance enhancing drugs. The same medications to treat these conditions could be used as PEDs; however, a proper diagnosis and prescription would prevent athletes from gaming the TUE status to 'cheat within the rules'.

Some fans may be concerned that immoral physicians will collude with cheating athletes to manipulate the TUE as a PED. However, most TUEs - including those for college students - demand a high level of documentation and biological/psychological testing.

There is a critical difference between treating a disease, and using a drug in a healthy athlete for a competitive advantage. If a well documented medical workup indicates a medical diagnosis, an athlete deserves treatment for that medical condition, even if that treatment utilizes a banned drug.