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The testosterone tribunal: the story so far

The medical tribunal into Dr Freeman, which starts tomorrow, could have serious consequences for Team Sky and British Cycling

British Cycling pursuit team 2007
Peter Stuart
5 Feb 2019

Tomorrow the former Team Sky and British Cycling doctor, Dr Richard Freeman, will head to Manchester to face charges of ordering testosterone to enhance the performance of an athlete, and various acts of dishonesty associated with that charge.

It is a serious hearing for the career of Dr Freeman, but it has far wider implications too.

When the UKAD investigation into the Team Sky’s delivery of a mysterious ‘Jiffy bag’ package ended in 2017, many thought that the issues were closed.

However, UKAD essentially passed on the investigation to the General Medical Council, becoming ‘aware of information that it considered to be of possible interest to the General Medical Council (GMC)’.

That information was sufficient for the GMC to bring charges over 11 separate allegations against Dr Freeman, which will be heard at the Medical Practitioners Tribunal Service beginning on 6th February in Manchester, to be concluded by 5th March.

So far, Dr Freeman has not been found guilty of any malpractice or unprofessional behaviour, and may be cleared of all charges. So, who is Dr Freeman, and what is the context surrounding these allegations, and the consequences they may have?

Who is Dr Freeman?

Dr Richard Freeman was at the centre of allegations surrounding Team Sky’s use of prescribed medicine throughout the Jiffy Bag scandal that began in 2016.

Prior to that, Dr Freeman came under fire for the prescription of Triamcinolone, a strong corticosteroid, for Bradley Wiggins’s hayfever uncovered by the Fancy Bears hack on athlete records. It was alleged that the therapeutic use exemption (TUE) was sought for performance gains rather than for therapeutic reasons.

He worked for both the Team Sky and British Cycling as team doctor between 2009 and 2015. Prior to that he had been head of medicine and head of sports science at Bolton Wanderers Footbal Club from 2001 until 2009, during one of the team’s most successful periods.

Dr Freeman was also involved in the hiring of Dr Geert Leinders as a Team Sky medic, who subsequently received a lifetime ban for doping offences while at Rabobank.

Freeman continued solely with British Cycling until March 2017, when he was suspended and investigated by British Cycling for his conduct as an employee. By September 2017 Dr Freeman had resigned from his position.

What has he been accused of?

Dr Freeman is accused of the following:

  • Ordering 30 sachets of Testogel (testosterone gel) from Fit4Sport Limited with the motive of improving the performance of an athlete, despite its use being prohibited by WADA.

  • In May 2011 making an untrue statement that the Testogel was ordered in error.

  • Requesting a written confirmation that the order was sent in error in October 2011, 5 months after the delivery.

  • In 2017 making untrue statements to UKAD that Testogel was ordered for a non-athlete member of staff and subsequently returned.

  • Administering non-urgent medical treatment to non-athlete members of staff and on three occasions not informing their GPs.

  • Failing to keep appropriate medical records during his time as team doctor for Team Sky and British Cycling, and failing to make those records retrievable when lost.

  • Inappropriate management of prescription-only medicine.

What is Testogel?

Testogel is a gel containing testosterone, the male sex hormone and anabolic steroid. The gel is usually contained in a 50mg sachet which is spread over the skin to transfer testosterone into the system.

Testosterone is part of WADA's list of substances prohibited at all times. It is known to increase muscle mass, and since the 1930s has been exploited by athletes for performance gains.

Testosterone does, of course, naturally occur within the body. However, any abuse of testosterone can offer further gains and also lead to side-effects such as shrinking of the male sex glands. Excessive levels of testosterone are detectable by a urine or blood test.

Testosterone has been used in the past to gain advantages in professional cycling, and Tyler Hamilton confessed to using a testosterone pill as a recovery aid in his book The Secret Race.

In 2011, 30 sachets of Testogel were ordered to British Cycling. Dr Freeman explained that these were delivered in error in May 2011, and in October 2011 an email from Fit4Sport Ltd verifying this was sent to British Cycling.

The GMC alleges that Freeman's statement, and the email, were untrue.

Why has the GMC, and not UKAD, brought charges against him?

During UKAD’s investigation into the mysterious Jiffy bag scandal, much of the focus was on the allegation that a package of Triamcinolone had been sent at Dr Freeman’s instruction for use by Bradley Wiggins at the 2011 Criterium du Dauphine.

That would have been outside of the permitted window of use under Wiggins's TUE. That allegation was never verified.

The DCMS Select Committe on doping requested Dr Freeman’s testimony, but he did not appear in front of the committee on account of ill health.

He was later criticised by MPs for attending an interview on the BBC despite his reluctance to face official questioning. He has repeatedly denied the use of prescribed medicine for performance enhancing benefits, and there has been no proof to the contrary.

When UKAD closed their investigation into the Jiffy bag, the UKAD chairwoman Nicole Sapstead claimed that UKAD met with a ‘degree of resistance’ as British Cycling invoked patient-doctor confidentiality, which she described as ‘frustrating’ to the anti-doping body’s investigative efforts.

UKAD closed the investigation into the Jiffy bag solely because it was unable to find evidence to either confirm or deny Team Sky’s claims that the Jiffy bag contained the legal decongestant Fluimucil, and not the prohibited drug Triamcinolone.

As the GMC is investigating the conduct of Dr Freeman, such barriers to the investigation will be far trickier. As part of this investigation the GMC has the power to require any information relevant to their charges. That’s a power that UKAD does not possess.

While the GMC is able to investigate any doctor, it is the MPTS (Medical Practitioners Tribunal Service) that will hear the case for and against Dr Freeman’s practice, based on charges made by the GMC.

The MPTS tribunal itself is like any normal tribunal, and operates on a civil standard of proof, and not a criminal one. The tribunal will hear both sides of the case. Dr Freeman will have a defence, possibly aided by officials at British Cycling and Team Sky.

What will the implication be for Dr Freeman?

Probity and honesty are hugely important virtues of the medical profession. If he is found to have been dishonest in his conduct, the MPTS may take the view that he is bringing the profession into disrepute and also question his ability to be a safe doctor in general.

In those circumstances he may be erased from the medical register, or issued ‘Undertakings’ – essentially restrictions on how he can practice – or a temporary suspension from practice.

In the event that the Testogel was not used as part of an anti-doping violation, it may spare British Cycling any controversy. However, as a controlled drug the prescription of testosterone is a serious matter, and the MPTS is likely to be harsh on any doctor prescribing these drugs in an informal non-urgent context.

Of course, Dr Freeman will have the opportunity to defend himself and his actions, and may be able to produce valid evidence to prove that his conduct was at all times acceptable and professional.

In that case he will continue to practise and be able to continue working in sport. 

Should all or part of the charges against him be proven true, then the MPTS will decide on the appropriate penalty – a decision they will need to reach independently of the GMC.

To be erased from the medical register would be the most serious penalty, meaning Dr Freeman would never be able to practise medicine again.

In 2014, the most recent year for which there is a publicly available record, 157 doctors were erased from the register or suspended from practice.

What will it mean for Team Sky and British Cycling?

Dr Richard Freeman is being investigated as an individual, and solely for his fitness to practise. However, the GMC will have to provide evidence for charges at the tribunal that may provide material for UKAD to reopen its investigation into Team Sky and British Cycling.

In UKAD’s statement on the closure of the Jiffy bag investigation, it stated,  ‘As with all investigations, UKAD may revisit matters if new and material information were to come to light’.

That said, the UKAD investigation solely centred on the contents of the Jiffy bag, and the focus of the GMC’s investigation has been the use of testosterone gel. For that reason we may see a new investigation open into the use of Testogel at British Cycling HQ.

Should this investigation reopen with new information, or a new investigation begin, any athletes involved could be issued retrospective sanctions and competition bans, as testosterone is banned from use in all circumstances under WADA rules. Such a ban could potentially change the outcome of races from 2011 to 2015.

Fundamentally, though, this tribunal is likely to shed more light on what UKAD considered to be a failure of compliance with anti-doping rules at British Cycling. Any findings of dishonesty will also be likely to erode the reputations of Team Sky and British Cycling too.

If the worst case scenario is confirmed, and Dr Freeman was indeed using testosterone for performance gains from British Cycling HQ in Manchester, the implications will be far reaching in terms of the management and governance of British Cycling and Team Sky.

It may also call into question the powers of investigation available to UKAD, as it was necessary for the GMC to assume the investigation in order to make any progress.

For Team Sky, during their search for a new owner and title sponsor, this timing could prove unfortunate.