The short story
In order to fully understand everything that has happened, I strongly encourage you to read the full article below, but this is a very short summary of what I want to say.
On 28th July 2023, I was notified by UK Anti-Doping (UKAD) that I had returned an Adverse Analytical Finding (AAF), also known as a positive test, for two substances. Formoterol, a medication I have been using for asthma for 4 years was detected at a concentration in line with how I have been prescribed it. The second substance, chlortalidone, a diuretic, was detected at a low concentration indicative of contamination. The presence of the contamination amount of the diuretic meant my asthma medication formoterol, which is normally allowed, initiated a second AAF.
I have spent the last 9 and half months of my life investigating, researching and writing my submissions to establish how the contamination event occurred. UKAD were insistent that I should have a two year ban despite the fact that both the concentration and the substance indicated a type of contamination which anti-doping bodies have been aware of for over a decade.
The matter was referred to a tribunal. Five days before the tribunal hearing, after previously stating that they would not change their position, UKAD in fact did a full 180. UKAD concluded that I was not at any fault and had exercised an extremely high level of care at all times in order to avoid ingesting a prohibited substance. UKAD therefore wanted to avoid a tribunal hearing on the basis that UKAD found me to bear “No Fault or Negligence” for the positive test and therefore have No Sanction and No period of Ineligibility imposed.
This process has cost me a huge amount, literally and metaphorically. My husband and I spent every penny of our savings and the huge mental toll has left deep scars.
But somehow, through it all, I knew I had to fight. Right from the start, I learnt of other athletes in the similar situations with a contamination of chlortalidone, whose lives and careers were also being torn apart. This process pushed me right to the edge and my fear that an athlete would go beyond that edge is what drove me to try and incite essential positive change. With my background in medicine, my good fortune in life to have had an excellent education and finally my dogged determination, I truly believed that if I couldn’t fight the injustices in this system, then no athlete could.
Prior to being completely cleared of any wrongdoing, I was repeatedly told by UKAD and lawyers that I would receive a two year ban. This simply didn’t make sense. No party thought I had “consumed” chlortalidone with any intent, yet that’s how the system works and my life continued to be torn apart for nothing.
It is difficult to emphasise enough how significant UKAD’s finding is that I bore No Fault or Negligence. To put it in black and white, I understand that this is the first time that UKAD has ever issued a finding of No Fault or Negligence (and therefore zero sanction) when the athlete has not specifically identified the exact source of the contamination.
I encourage you to read the full article below to have a complete understanding of the process. I believe you will find the behaviours of the World Anti-Doping Agency (WADA), UKAD and the pharmaceutical industry to be shocking and at the very least, the thorough documentation below will provide you with a far better appreciation of the anti-doping system, its treatment of athletes and, most importantly, how it is currently failing honest and hardworking people.
Finally, I encourage respectful comments and discussions, whatever the opinion, but I kindly ask you to think carefully about the impact what you say will have on me and my loved ones. Please therefore: read the story in full and understand all the facts before making a judgement or commenting hastily and please remember that behind the computer screen is a human who has been going through hell for months now.
Lizzy Banks
The full story: From before the start to not yet the end
Introduction
Most people visiting this page will have followed my career, listened to my podcasts, know my story and as I have always been an open book, will likely know quite a lot about me already. For those who don’t, my name is Lizzy Banks and I was a professional cyclist between 2018 and 2023. In the last couple of years of my career I was plagued with health problems. A severe flare up of my long-standing asthma caused difficulty breathing in 2020, a serious concussion wiped out my 2021 season and Olympic hopes, and just as I was raring to go in 2022, Covid-19 struck me for the first time which led to pericarditis (inflammation of the lining of the heart) and a number of associated health issues. I was relieved to finally have my health back in 2023. I slowly clawed back my fitness and started to race again. Many people thought I would never get back but I defied the odds and was slowly and surely working towards being the Lizzy Banks I used to be. My last race was the Giro d’Italia in July 2023, a very special race for me, having taken two world tour stage wins in both 2019 and 2020. At the time, I had no idea that the Giro d’Italia would in fact be the last cycling race of my career.
The weeks following the Giro were complicated for me. A nasty crash at 70kph on the penultimate day took the skin off one side of my body and inevitably led to difficulty sleeping and a delayed recovery. The day after I got home, I got a call to say I hadn’t been selected for the Tour de France Femmes. I felt it was the wrong decision and under normal circumstances, I would have challenged it, but the night before the call, my foster brother had fallen out of a tree in the Caribbean and was at that moment lying in agony in a hospital, paralysed waist down with a shattered spine and a compressed spinal cord. Tour de France Femmes selection was no longer my number one priority.
Visiting my foster brother in hospital in the UK in August. Fortunately he has made incredible progress in his recovery.
On 28th July I set out for what was going to be my first 4 hour ride since the Giro. Finally things felt like they were getting back on track. My brother had had a successful operation and been repatriated, I had finally recovered from the Giro crash and the sleep deprivation from spending most nights on the phone to the Caribbean and most days on the phone to the NHS. It seemed like my body was on the mend and had absorbed the training effect of the Giro. While riding that day, I felt good on the bike, physically and mentally. With the temperature over 30 degrees, I stopped around halfway in a small village called Seyssel near the Grand Colombier and popped into a bar to grab a coke and a snack pack of Pringles. I checked my phone and saw an email from UK Anti-Doping (UKAD). That in itself wasn’t particularly unusual but the content of the email was. The email read:
“Dear Ms Banks,
UK Anti-Doping (‘UKAD’) needs to send you private and confidential correspondence. Please confirm you are able to receive this correspondence at this email address.
Alternatively, please provide a suitable address.”
The message struck fear into me. I immediately responded and messaged my husband with my brain going into overdrive and assembling the worst-case scenarios. I had been so careful throughout my career to avoid risks of contamination. I knew from other well-publicised cases that the “strict-liability” rule meant that even if the anti-doping authorities don’t think you have ingested a banned substance intentionally, then it is the athlete who bears the burden of proving contamination and that they did not bear any fault or negligence. If the athlete can’t do that, they will get a minimum two year ban.
Five painfully slow minutes later, UKAD replied to me with an attachment. I opened it and felt sick from the horror I was reading. My head was spinning at a hundred miles per hour and I couldn’t comprehend the mass of bold and red highlighted writing in front of me. I hurriedly flicked through the ten page correspondence, trying to make sense of what I was seeing. Nothing made any sense.
The letter from UKAD repeatedly stated that I was being served notice of a provisional suspension and that I may have committed Anti-Doping Rule Violations (ADRVs). The letter stated that these violations could mean a two year ban.
The letter stated I had returned Adverse Analytical Findings (AAFs, more commonly just referred to as a positive test) for two substances: formoterol and chlortalidone. Formoterol is a medication I take for asthma. I have been taking it for years well below the anti-doping threshold so I didn’t understand how that could possibly be correct. After a quick google, I discovered that chlortalidone is a diuretic used for high blood-pressure and swelling. That also didn’t make sense as I was sure that it wasn’t present in any of my medications.
I immediately called my husband, followed by my dentist. My first thought was that it must be a mistake. I had spent 2 hours at the dentist the day before the test. The dentist couldn’t obtain satisfactory anaesthesia and had to use a lot more anaesthetic than usual. I had documented this on my anti-doping form. Somehow, I thought, it must be something that was in the dental injections that shouldn’t have been. It wasn’t. The dentist told me that chlortalidone definitely wasn’t used. Then I phoned my agent. I had no idea what to do. How in the world was I going to work out what had happened? The anti-doping test was carried out 79 days before I received the notification from UKAD. How on earth did I have any chance of finding a trace concentration of something that had got into my system by contamination nearly 3 months ago? It would be like looking for a needle in a whole barn full of haystacks.
Overwhelmed and in despair in Seyssel village square, I sat waiting for my husband to come and rescue me. I was 50km away from home and in no state to ride anywhere. He arrived and in all honesty we were both a complete mess. The effort and sacrifice we had put into cycling for so many years and the extreme precautions I took with anti-doping made this situation completely unbelievable. I took my anti-doping obligations incredibly seriously because I knew contamination was a serious risk and I also knew that if it did ever happen to me, I would be completely screwed because the chances of being able to prove one’s innocence are so slim.
Still fixated on the dentist, we drove straight there. They let us look through every single medication they stocked. I studied everything but nothing had chlortalidone listed as an ingredient. The dentist I saw was away on maternity leave. “Perhaps she had pre-eclampsia and needed a blood-pressure medication, and somehow the contaminant entered my system this way?”, I remember thinking. The receptionist phoned the dentist for me, but she hadn’t been taking any medication.
Still in my cycling kit and shoes, we went straight to the dentist. We looked through every medication they stocked and checked it for chlortalidone. We took photos of everything that had been used in my treatment to keep as a record.
Within 5 minutes of getting home, I was on the phone with my team owner. I told her everything I knew and I was hysterical with the overwhelming emotion and helplessness of the situation. Mid-call, I got a call back from Mike Morgan of Morgan Sports Law who are specialists in anti-doping proceedings. That first call was the beginning of a long process of research and discovery which has completely changed my understanding and, unfortunately, my faith in the world of anti-doping.
Overview
Since 28th July 2023, I have worked relentlessly to understand, investigate and ultimately demonstrate how my sample could have come to be contaminated with chlortalidone.
The rest of this article will outline the steps I took, the research I did and the horrifying discoveries I made about the absence of preventative measures in the anti-doping system to protect honest and hard-working athletes from contamination risks that WADA have known about for at least a decade. This article will also document the actions of UK Anti-Doping (UKAD) throughout this process, many of which demonstrate why I believe that UKAD (and for that matter WADA) are not currently fit for purpose and require a complete overhaul.
Where did it come from?
From that very first call with Morgan Sports Law, the enormity of the task that lay ahead became apparent. I learnt that the contamination really could have come from anywhere. Supplements, pharmaceuticals (yes, you read that right), food, water, surface contact with the contaminant, contamination through medication of visitors staying in my house. Tracing the source would be hard enough if I had found out the day after the anti-doping test, but 79 days had already elapsed.
Five days before notification by UKAD, my husband and I were celebrating our anniversary at a local Swiss pub. When we went to pay, my husband noticed a sign behind the bar saying New Zealand lamb may contain traces of growth hormones. I was terrified and took a photo to keep as a record “just in case” even though we had eaten a vegetarian meal and hadn’t even ordered lamb.
From 28th July onwards, I was completely paralysed by fear. I had absolutely no idea where the chlortalidone had come from. I stopped taking my medications. I was afraid to eat just about anything; meat, milk, anything that had been through any kind of process, even drinking water concerned me. The extreme stress of this horrifying situation set in and my physical health started to deteriorate. Within a week I was already beginning to have a crisis with my asthma. I knew I needed to take my medications just to keep me healthy, but the anxiety crippled me, knowing now that any of my medications could be contaminated and that anti-doping could turn up again at any minute. Before long I had no choice, I was struggling to breathe properly and I was forced by my poor health to start taking my medication again. Every time I took it I was racked with fear. So many times I broke down in tears and panic just because I had to use my inhalers and take my tablets. It was inhumane. No athlete should live in fear like I was. Health is a human right and choosing to work as an athlete is not a reason that such a fundamental right should be stripped from you.
My mental health was shattered. I was a complete wreck. One of the first bits of advice I was given was “keep the circle small” in order to avoid leaks to the media. In the first days I told the people I needed to tell, those who I worked for and those who had visited my house in the period preceding the test but to everyone else I remained silent. The silence was eating away at me internally, but it was a double edged sword. I needed the support from close friends but at this point, explaining the story and trying to convince people I wasn’t a doper just felt so overwhelming. I felt that my life was over, that I had nothing left. I thought that I would be put in the bin by everyone I knew, that I would be disowned and that I had lost every single thing in life I had worked so hard for. Not just my job, my income, my current and future career prospects but every relationship I had nurtured in life.
Although the feeling that my life was over did not leave me, as I slowly told more and more people, it became clear that in fact not one single person thought that I was a doper or had done anything intentionally. After reciting the same agonising story a critical number of times, I realised that I didn’t even have to say “I would never take a banned substance”. The sentence was superfluous to requirements. These people knew me inside out, they knew my morals, my staunch belief in fairness and how I have always spoken out for what I believe is right. The story was so ludicrous and to anyone who wasn’t UKAD or WADA, it seemed obvious that I should not face a ban.
“Guilty until proven innocent? But that’s the opposite of the legal system?” I heard that crushing phrase so many times.
As July gave way to August, my first task was to make a detailed list of every medicine and supplement I had consumed at the end of April and first two weeks of May. Details of brands, batch numbers, photos and precise details of when each thing was consumed. I also made a list of everything I ate and drank, everywhere I had been, everyone who had stayed at my house or I had been in contact with and what supplements or medications they had consumed.
The fact that supplements are not controlled in the same way as pharmaceuticals is really hammered home in anti-doping education and it’s common knowledge that shop bought supplements can even be purposely laced with banned substances. When you hear about doping cases in the news, it’s almost always due to supplement contamination. Lesson one at anti-doping school is about the risk of supplements and if you must take them, only take ones which have been batch-tested for banned substances.
I could not see how supplements could be the cause of the positive test in my case. I have always been fastidiously careful about them. I didn’t even allow my husband to buy cheaper cycling nutrition for himself because I was so scared about cross over contamination. Since moving to France, I couldn’t access the brands that I have always used and trusted so I would ship products to the UK and go back and pick them up. At home I only used Science in Sport and Healthspan for sports nutrition and supplements. I had been using these products for years and I also knew that I was using the same batch of supplements that I had been using when my previous anti-doping test took place. The very few supplements I was taking were specifically to help with the medical problems that I had.
Once I had ruled out contamination from visitors to my house, I focussed my search on pharmaceuticals.
Chlortalidone in my urine sample
My urine sample tested positive for an estimated concentration of 70ng/ml chlortalidone. While I was sat there panicking about what this meant, my husband reminded me that one nanogram is a billionth of a gram. That fact in itself isn’t really the important bit. The concentration of a substance and whether or not that concentration is indicative of contamination is more complex than that. It depends on both the substance’s half-life (the amount of time it takes for the concentration of the substance to decrease by half in the body) and the potency of the substance, meaning the quantity of a drug that must be ingested in order for the drug to have an effect.
If an athlete really was idiotic enough to want to cheat, then chlortalidone would literally be the last substance on earth to choose. Chlortalidone is a diuretic. Diuretics are not considered to be performance enhancing drugs. Diuretics are banned because they have the potential to act as a masking agent for performance enhancing drugs such as anabolic steroids. This masking effect could only occur when a large enough quantity of a diuretic has been consumed in order to greatly increase the amount of urine produced, therefore diluting the concentration of the banned substance in the urine.
Before this process, I never really understood the meaning of what a masking agent was, believing it to somehow “hide” the biochemical properties of another drug. In fact, it means that any drug which is trying to be masked (such as anabolic steroids) would still be detectable, but at a lower concentration due to dilution. The “masking agent” would then still be detectable as per its normal half-life.
Chlortalidone has by far the longest half-life of any diuretic prohibited by WADA. The average half-life is 48 hours but it can be as long as 89 hours. The diuretic with the next longest half-life is hydrochlorothiazide with an average half-life of 7-8 hours. Other diuretics, such as bumetanide, have half-lives as short as 1 hour.
This means that any ingestion of chlortalidone would take around 2 weeks to be fully excreted from your body (and due to individual variation, could be much longer). Whereas a drug such as bumetanide would be eliminated and untraceable after around 7-8 hours. Even hydrochlorothiazide would no longer be detectable after 2-3 days. Add to this the impact of the potency of the drug and chlortalidone becomes an even more unsuitable target for athlete abuse. An effective dose of bumetanide is 1mg. An effective dose of chlortalidone is 25-50mg and one single dose is very unlikely to be enough to have any effect as a masking agent. Analysing these aspects of potency and half-life in tandem is very significant when understanding the significance of the estimated urinary concentration of a substance.
The concentration of chlortalidone in my urine sample was multiple orders of magnitude lower than what would be detected following a single medically effective dose1. In the case of chlortalidone, one may expect to see a concentration of around 5000ng/ml, 48h following a single dose. This would greatly increase if more than one dose was taken.
WADA specifies something called a Minimum Required Performance Level (MRPL). The MRPL specifies the lowest level at which a laboratory must be able to detect a substance in order for the laboratory to be WADA accredited. WADA has set this MRPL to ensure detection in a uniform way2. For all diuretics the MRPL is set by WADA at 200ng/ml. However, not all labs are made equal. Whilst all labs must be able to detect diuretics down to 200ng/ml, some labs can detect substances down to the picogram (that’s one thousandth of a nanogram (or one trillionth of a gram)). The 200ng/ml MRPL, however, is not a Minimum Reporting Limit.
A Minimum Reporting Limit (MRL – not to be confused with the MRPL above) is the concentration below which a a given substance will not trigger a positive test. There are very few banned substances which have a MRL. Most substances have a zero-tolerance policy, even if tiny concentrations are detected (such as contamination concentrations) of substances that are medically and physiologically irrelevant at that level.
Having a MRL lower than the MRPL means that one sample could be analysed at two separate laboratories with one returning a positive while the other does not. How WADA can state that this system ensures uniform detection and therefore fairness is absolutely beyond me. Conversely, it does the opposite.
It seems reasonable that there are two very simple measures that anti-doping organisations should have in place.
A Minimum Reporting Limit specific to each substance (considering its half-life and potency) which is at least the level of the MRPL.
When low concentrations of substances are detected that could be the result of contamination, not to automatically issue an AAF, but create an internal flag to re-test the athlete as soon as possible and more frequently to determine the likely cause of the low concentration.
From the outside, it would be reasonable to expect that WADA know what they are doing and that, in fact, measures such as these are already in place. From my experiences, that is so far from the reality. There are very few substances for which a minimum reporting limit applies. For substances without a minimum reporting limit, no matter how small the concentration, an AAF is always automatically created.
Once an AAF is created, it is then the sole responsibility of the athlete to prove exactly how the substance entered their system. That is an incredibly difficult thing to do as the standards of proof are very high. It is also a very costly thing to do and navigating the complex legal world of anti-doping is confusing and overwhelming. All this when an athlete is at their most vulnerable.
When I first told my best friend about what had happened, he said:
“It’s like there’s been a murder and just because you were on the street at the same time, you are being charged for murder.”
In fact, it’s more than that. You are being charged for a crime, but you are also being told that the police aren’t going to investigate anything themselves. You are guilty until proven innocent and you have to pay every penny of the investigation yourself with no help from the police.
So that’s it. Everything points to contamination, but that’s what UKAD say. Two year ban unless you can find that needle in that barn of haystacks. Oh and by the way, that needle was put there 3 months ago. The haystacks aren’t there anymore but good luck finding them and that needle.
A short history of contamination
Prior to 28th July 2023, I had no idea that pharmaceuticals could be (and commonly are) contaminated with banned substances, such as diuretics. I also had no idea that water was a potential source of contamination with banned substances. Neither of these facts have ever been taught in anti-doping education. Perhaps that is because WADA know that there is nothing athletes could do to avoid contamination from these sources.
WADA have acknowledged that recent advancements in the sensitivity of testing mean that detection of trace contaminants from banned substances in pharmaceuticals are able to cause an AAF3. Many World Anti-Doping Agency (WADA) accredited laboratories can now measure contaminants down to the level of picograms (one trillionth of a gram). One would rationally expect that an organisation like WADA would have robust systems in place to proactively identify contamination risks to athletes and create measures which prevent athletes from inadvertently testing positive through no fault of their own. Unfortunately, however, that is not yet the case. WADA is not even nearly there. In fact, WADA is, in my opinion, actively failing athletes on a huge scale. Surprisingly, I received an email from WADA stating in black and white the scale of their oversight with regards to contamination issues. More on that later.
In the early days of my research, I spent a huge amount of time studying all of WADA’s rules. There was so much to get through and so many surprising inconsistencies. .
Given the fact that athletes have never been warned about the risks of pharmaceuticals, it is surprising that WADA’s rules are actually very clear on the importance of athlete education in order “to prevent intentional and unintentional doping”. The WADA code itself even states that Education programs are “intended to preserve the spirit of the sport and the protection of Athlete’s health”. WADA’s rules also say that “Education should be evidence based” and that “Education programs should raise awareness by highlighting topics and issues related to clean sport”.
However WADA has not sufficiently (or in fact ever) educated athletes on the risk of contamination from pharmaceuticals and WADA has done very little to protect athletes from these contamination events. WADA has allowed the detection science to progress and acknowledged the problem, whilst simultaneously ignoring the consequences. Athletes’ lives and careers are being destroyed overnight because WADA are not keeping pace with technological advancements.
WADA and diuretic contamination
For at least a decade, WADA has been aware that diuretics can be contaminants of both water and pharmaceuticals at a level high enough to trigger an AAF.
Just down the road from where I live, Lake Geneva (Lac Léman in French) is considered to be one of the cleanest lakes in the world. I’m sure it would surprise you to know that 3 years ago, ecotoxicologist Natalie Chevre said that there were at least 50 tonnes of pharmaceuticals and 12 tonnes of pesticides in Lake Geneva4. After ingesting a medication, it doesn’t just disappear. A proportion gets filtered out of you, it ends up in the sewers and most sewers don’t filter out all pharmaceuticals, so then it ends up in the water. You may remember seeing headline news about the concerning levels of oestrogen present in Britain’s tap water due to widespread use of the contraceptive pill, and the concern for its impact on male fertility levels5,6. Fortunately, the contraceptive pill is not a banned substance. However, diuretics, which are one of the most commonly used classes of medications, are banned in sport. Every person reading this will probably know someone who is taking a diuretic. Their use is ubiquitous worldwide to treat high blood-pressure, heart failure, liver cirrhosis and a whole host of other medical conditions. Consequently, these diuretics end up in our water. Look hard enough and in small enough concentrations and you will begin to realise that everything is everywhere.
In 2013 Jack Burke, one of the best junior cyclists in the world at the time, tested positive for 1ng/ml of the diuretic hydrochlorothiazide7. He was found to have No Fault or Negligence and no period of ineligibility was imposed on him, as the positive test was the result of ingesting contaminated water. Despite there clearly being no way Jack could have possibly known that the water he was drinking was contaminated with a minute amount of a banned substance, Jack, like me, still has Anti-Doping Rule Violations (ADRVs) to his name for both “use” and “presence” of the banned substance.
Yes, you read that correctly. An athlete goes through hell after having done absolutely nothing wrong. The relevant body then clears the athlete of all wrongdoing and the athlete is subject to no ban, yet the athlete is still “guilty” of having “committed” ADRVs. In Jack’s case, he tried for years to get a World Tour contract but the harsh reality was that because of the way this system works, teams and sponsors could not and would not touch him. A two year ban is effectively a life-sentence. Even being cleared of all wrong-doing, like me and Jack, is still a life-sentence, especially in cycling. WADA must change their rules in this respect to address the implications for athletes who are found to not be at any fault.
In 2014, a Swiss athlete returned an in-competition positive test for a low concentration of Hydrochlorothiazide. With help from Antidoping Switzerland and the institute for preventive doping research in Cologne, Germany, the source of the contamination was investigated and was found to be due to an over the counter pharmaceutical, an NSAID (e.g. Ibuprofen)8.
However, the contamination that occurred in the case above is not a one off. In fact, it is common and fell within the purity limits for pharmaceutical production that are governed by a regulation called “Good Manufacturing Practices”. This information in isolation should be incredibly concerning for athletes. Good Manufacturing Practices (GMP) allows for a certain proportion of a drug to be contaminated. The reason this contamination limit is in place is purely a safety feature to ensure that the drug meets its pharmacological purpose. Drug companies do not have to make sure their products are 100% pure and completely free of contamination from other active pharmaceutical ingredients. Of course, pharma companies are not bound by the zero-tolerance policies which WADA sets and by which athletes must live. But worryingly, WADA do not properly account for the fact that pharma companies produce products which are not 100% pure and can cause inadvertent positive tests for athletes. As you can see, this leads to a rather large problem.
WADA’s Fundamental Rationale for the World Anti-Doping Code9 states:
“Anti-doping programs seek to protect the health of Athletes and to provide the opportunity for Athletes to pursue human excellence without the Use of Prohibited Substances and Prohibited Methods.”
Given that WADA do not provide adequate protection or mechanisms to prevent athletes receiving bans due to contaminated medications, it is simply not possible that WADA can be protecting the health of athletes.
In a later section I will detail the shocking scale of contamination that is rife in the pharma industry at a far higher level than is allowed even by the GMP regulations.
Anti-doping experts undertaking the study above8 found that the level of contamination of the NSAID was within the limits set by GMP. As a result, the experts recommended a minimum reporting limit of 200ng/ml should be put in place for ALL diuretic substances in order to avoid inadvertent positive tests due to legitimate use of permitted pharmaceuticals. This study was published in April 2016. It is important to note that it is rare for anti-doping organisations to actively investigate the source of a positive test and go to the lengths that they did here in commissioning a scientific study proving the risks that pharmaceuticals pose to clean athletes. Normally, that task and the associated costs fall solely on the athlete.
WADA was aware of this case and should have known a 200ng/ml Minimum Reporting Limit had been recommended based on a scientific experiment by experts at the forefront of anti-doping research.
However, WADA did nothing and athletes continued to pay the price.
As the sensitivity of testing crept up over the years since, so did the number of positive tests. This wasn’t simply because more tests were being carried out, but in fact from 2016 onwards the proportion of tests positive for a diuretic substance started increasing as well. A simplified explanation may be just to say “WADA is catching more cheats than ever before.” But is that really the truth? How many athletes are really using diuretics in order to cheat when diuretics alone don’t even have a performance enhancing effect and when the testing is so sensitive that they know it’s going to be detected anyway?
In 2019, WADA finally created the “Contaminants Working Group” with a mandate:
“To be responsible for providing expert advice, recommendations and guidance to WADA Management with regards to prohibited substances that are contaminants.”
Concurrently, a number of experts were working with the United States Anti-Doping Agency (USADA) on a scientific study having had numerous athletes test positive for diuretic substances due to contaminated pharmaceuticals1. In this USADA study, the only common factors between contaminating substances were that they were diuretics and that the medications were generic.
A generic medication is one with the same active-ingredients and pharmacological characteristics as a brand-name drug, but usually costs a lot less to produce. Generic medications are often manufactured in the far east due to lower production costs and a factory may produce many different types of medications in the same facility. I will discuss later the poor standards and cross-contamination issues in production of generic medication.
In the USADA study, 5 diuretics were identified as contaminants, all of which have significantly shorter half-lives than chlortalidone. The study concluded that a minimum reporting limit of up to 100ng/ml would be appropriate for those particular substances. The study also provided excellent graphical representation of the clear demarcation between low level tests, most likely indicative of contamination, and the clustered tests in the 1,000-10,000ng/ml range which are more clearly indicative of use of a medically relevant dose of the drug1.
Mario Thevis, an expert at the forefront of anti-doping research, published a paper in 2021 specifically warning about pharmacokinetic outliers10, “drugs with particularly long elimination periods and corresponding detection windows” (such as chlortalidone) and the care and attention that must be paid to low level positives to ensure that athletes are not unfairly penalised. Critically, Thevis stated:
“Often, uncovering these scenarios takes immense effort and cost, and in some cases, athletes proving their innocence may be virtually impossible due to the lack of identification of the original source.”
WADA letting the cat out of the bag
This is what my life looked like for months. Trawling through mountains of rules and scientific studies. Marcus provided occasional enforced breaks by lying on top of my computer.
I wanted to quiz WADA about chlortalidone. I knew of multiple athletes in similar situations as me. Surely WADA must be aware that chlortalidone is a contaminant and be in the process of adding it to their list of contaminants? Morgan Sports Law emailed WADA with a lawyer-ised version of my questions. WADA’s first response was that:
WADA’s very short first response to our enquiries regarding chlortalidone contamination
“Chlortalidone is not known as a contaminant of medication (or Meat). There is therefore no reason for the Contaminants Working Group (or other WADA group or body) to consider introducing a MRL for this substance”
These two lines of seemingly nonchalantly presented text simply wasn’t satisfactory. I was determined to get more information from WADA. In WADA’s second email response, they told us the number of positive cases there have been in previous years and how many there had been so far in 2023. Yet WADA even managed to get this bit of information wrong as the figures they gave didn’t match their publicly available records.
I wasn’t satisfied and I asked Morgan Sports Law to press again. This is when WADA seemed to get frustrated with my questions. WADA’s full response read as follows:
WADA’s third email with some rather shocking revelations
“WADA does not keep a log of all products (if any) that have been asserted or found (rightly or wrongly) to have been contaminated with chlortalidone (or other prohibited substances). Moreover, and more generally, WADA does not have the (human) resources to conduct research in respect of matters arising in first instance cases (of which there are hundreds at any given time) to which it is not a party.”
WAIT. WHAT?
Hold on a minute. The World Anti-Doping Agency DOES NOT KEEP RECORDS of which substances have found to be contaminants? Then who does?
WADA literally just told us that “ Chlortalidone is not known as a contaminant of medication (or Meat). There is therefore no reason for the Contaminants Working Group (or other WADA group or body) to consider introducing a MRL for this substance .”
But they also told us that they don’t keep any records of what substances are contaminants. So how can they possibly know whether or not chlortalidone is a contaminant of meat or medication?
WADA has a contaminants working group that is specifically designed to “assess the risk associated with legitimate medicines based upon real cases (e.g. diuretics in pain medication).” How can that group possibly be fit for purpose when the critical information they need is not even recorded by WADA?
I had so many emotions reading that email. I was furious, devastated, helpless, destroyed, shocked and frustrated that WADA seemed to be so flippant about a subject that was literally tearing my life apart.
Throughout this process, I had studied a huge amount of caselaw from the Court of Arbitration for Sport (CAS – the most senior court in anti-doping). One case in particular (CAS 94/129 USA Shooting v. UIT)11 had the most wonderful quote in it which felt so apt in light of the revelation that even WADA does not keep appropriate records. In this particular case, CAS was unequivocal about the standards that the regulators of the rules should meet11:
“The fight against doping is arduous, and it may require strict rules. But the rule-makers and the rule-appliers must begin by being strict with themselves. Regulations that may affect the careers of dedicated Athletes must be predictable“
I was speechless after reading WADA’s emails. Marcus provided a more visual representation of exactly what he thought of WADA’s rules and their behaviour.
WADA’s contaminants working group
Without being present at the meetings, it is difficult to say whether WADA’s contaminants working group has failed in meeting its mandate12, or whether WADA has failed in executing recommendations of the contaminants working group. Whether or not either of the above has occurred, we know from WADA’s emails that WADA has not kept adequate (or any) contamination records with which to provide the working group accurate information.
In June 2021, 8 years after the Jack Burke case with water contamination and 7 years after the Swiss athlete case with a contaminated pharmaceutical, WADA released a statement concerning diuretic contamination13.
WADA had decided to introduce a minimum reporting limit, but only for 6 diuretics and only at 20ng/ml13 (180ng/ml lower than the Minimum Required Performance Level for WADA accredited labs and Minimum Reporting Limit recommended by experts in the USADA study1).
I cannot possibly understand why WADA only gave a minimum reporting limit to 6 diuretics. There is no credible scientific reason why these 6 diuretics would be contaminants of medications whilst others would not. There is nothing in the chemical structure of these 6 drugs which means they are more likely to be left as a residue in the manufacturing process and therefore become a contaminant. There is no indication that these 6 drugs are more likely to be manufactured in facilities where cross contamination is more likely to occur.
The 6 diuretics for which WADA gave a minimum reporting limit were the 5 that USADA studied1 and one other. It seemed that WADA were expecting external organisations to do the research for them. USADA1, Swiss anti-doping8 and very wealthy athletes who have a huge amount of money at their disposal to commission scientific studies.
It also appears that WADA either couldn’t or didn’t thoroughly assess their own data. So I decided to do it for them.
WADA provide publicly available records of the numbers of tests and AAFs each year. Unfortunately, there is no public data on the concentration levels of the positive tests, however, some of that can be inferred from the table below.
I collated all the data from all AAFs for diuretic substances between 2008 and 2022. There is a lot of information to digest so I will pick out the main points.
NB: When I presented this data to UKAD, the 2022 data were not yet available but have since been made public and therefore included.
The original table can be downloaded below.
From 2015 onwards, as the testing equipment became more advanced, the percentage of samples that returned a positive test for a diuretic steadily increased.
In the years 2014 and 2015, 0.14% of samples were positive for a diuretic. By 2019 that figure had increased to 0.24%.
In June 2021, WADA introduced their minimum reporting limit of 20ng/ml for 6 diuretics. That meant that any test at that level or below would not be reported at all. This limit was backdated for the 2020 and 2021 testing figures.
In 2020, with the figures adjusted for the new minimum reporting limit for the 6 diuretics, the percentage of samples positive for a diuretic suddenly dropped back down to 0.14%, the lowest seen since 2015. In 2021, that figure was 0.13%, the lowest since 2012.
The sudden drop in percentage of positive tests from 2019 to 2020 represented a 42% reduction in the number of athletes returning a positive test. Comparing the 2021 figures with the 2019 figures, we see a 46% reduction in positive tests.
But what does this actually mean? It means that at least 40% of the tests carried out could have been positive at a level indicative of contamination. I say “at least” because you must remember two things: the minimum reporting limit was only introduced for 6 substances (out of at least 37); contamination can cause concentrations well above 20ng/ml depending on the substance and its half-life.
Based on the 2019 and 2021 figures, it is possible that 316 athletes returned positive tests due to contamination in 2019 alone. This estimation is only for the 6 specific diuretics. The real figure is likely to be much higher.
How does WADA compensate athletes that have been wrongly accused of cheating? How do they give them back those two years of life? Repay them for all the lost earnings and legal fees? Repair their shattered mental health? The short answer is, they don’t.
My care with anti-doping
Everything I was going through was horrific and part of the reason it hurt quite so much was because throughout my career I put an immense amount of effort into my anti-doping responsibilities. It is only now that I am officially “retired” (thanks to all this) and no longer on whereabouts, that I realise quite how much energy I consumed worrying about it.
Whereabouts is the system athletes use to provide the testing authorities with athletes’ locations three months in advance. Athletes must provide detailed information about overnight accommodation, regular activities, travel and racing schedules.
I was able to provide UKAD with evidence of so many times when I had gone to great lengths to ensure I was meeting my anti-doping obligations. I showed UKAD emails documenting how doctors had repeatedly asked me to increase my asthma medication because I was so unwell and I flatly refused because I was terrified about nearing the anti-doping limit for my inhalers. I refused the use of a nebuliser for asthma when I was so unwell I couldn’t walk upstairs because I knew I would need to apply for a TUE (Therapeutic Use Exemption). Athletes use a website called GlobalDRO which provides accurate and up to date information on whether a medication is safe to take in and out of competition. I always checked and rechecked all my medications for banned substances even if it was a medication I used repeatedly. I only ever used batch tested supplements and nutrition and I used them sparingly.
I was fastidious with my whereabouts, providing exceptional levels of detail for how to find my location, wherever I was. I had a nightly alarm to remind me to update my whereabouts so that if I was travelling unexpectedly or needed to update my hotel room number I wouldn’t forget. I realise now that all the worry about complying to every letter of the rules cost me dearly whilst I was a professional. It cost me in stress and it also cost me in quality and quantity of sleep as I was always so anxious about the consequences of not hearing the doorbell or a knock on a hotel door when wearing earplugs.
The irony of all that worry when the one potential source of contamination that I couldn’t control and had no idea was a risk was right there in front of me. My medication. No reasonable person would expect that a medication could be contaminated. But WADA knew and had known for years.
The true scale of pharmaceutical contamination
Having had a number of serious illnesses the past few years, I had to take a number of medications. I was always meticulous about listing all of my medications on my anti-doping forms and had done so for this test too.
After discovering that pharmaceuticals could be and often were contaminated with banned substances, I started to do more research in to the subject. I suspected that the contamination of pharmaceuticals could be worse than WADA were letting on, but I didn’t yet have any proof.
Preparing a mountain of mince pies for a Christmas friends dinner using Josceline Dimbleby’s fantastic recipe. These simple pleasures provided me with excellent distraction. My husband and I had a Christmas lunch with our friends. They were all worried about us and asked how we were getting on. It just so happened that one of our friends worked in the pharmaceutical industry. When explaining what I had found out about contamination of medication, my friend almost laughed out loud. He told us all about the notoriously poor standards within the pharmaceutical industry and stories of factories being contaminated with rat faeces. Well, if the factories can’t even control rat faeces, then can they really prevent cross-contamination of medications produced using the same equipment? He pointed me in the direction of the FDA, the American Food and Drug Administration who have ample publicly available records from their inspections of pharmaceutical facilities. I simply wasn’t prepared for what I was about to find out.
In 2021, Bloomberg reported on cross-contamination issues in big pharma and how it was so serious that it could jeopardise Olympic dreams14. Bloomberg shed light on how deep the issue of cross-contamination runs and the sloppy standards plaguing the pharmaceutical industry. Bloomberg reported that:
“Manufacturers stamp out pills for one condition on the same machines they use to stamp out pills for a different one, and while they’re supposed to clean between production rounds, trace contamination is common and, some argue, inevitable.”
I started trawling through the hundreds of publicly available FDA records15. The FDA has to give factories advance notice of inspections, yet here are just some of the shocking findings that were reported by the FDA.
Swab samples with 800 times the acceptable limit of previously manufactured drugs 16 .
the acceptable limit of previously manufactured drugs . At one firm, direct and indirect contact surfaces had not been cleaned or examined for cleanliness since installation over 14 years ago 17 . During the inspection, residue samples were collected at the end of placebo batches and subsequent cleaning, which also demonstrated active ingredient cross-contamination on surfaces 17 .
. During the inspection, residue samples were collected at the end of placebo batches and subsequent cleaning, which also demonstrated active ingredient cross-contamination on surfaces . Original test reports torn up and discarded in plastic bags. Destruction of finished drug product records by an analyst who put them in a bin and poured acid on them 18 .
. Visible thick build-up of material on equipment marked as “cleaned” 16 .
. Multiple occurrences of visibly contaminated tablets and capsules19.
I could go on for a really long time, but I will spare us all. I’m sure you get the picture. The pharmaceutical industry isn’t as squeaky clean as they would like you to think. Not even nearly.
My conclusion, like Bloomberg’s, was that it was therefore not surprising that pharmaceuticals were contaminated, but it was inevitable. It was also therefore obvious that athletes who are undergoing treatment for chronic health conditions and are required to take regular medication are at a disproportionately increased risk of being the casualty of a contamination event and an inadvertent positive test.
Anti-doping regulations have not sufficiently adapted to the compounding factors of the rapid growth of the complex pharmaceutical supply chain leading to poor quality pharmaceuticals and the increased sensitivity of scientific testing methods enabling detections of very low concentrations. As a result, hard-working, honest and innocent athletes risk being penalised for protecting their health and instead have their careers and lives destroyed.
My search for the contaminant and exhaustion of my resources
My previous anti-doping test was two months prior on 14th March 2023. I compared my doping control forms for the differences in medications between the two tests. This helped to narrow down my search for the source of the contamination. I knew that I did not still have the original batch of most of these medications. But there were two medications left in the cupboard which could have been from the same batch as that I had been taking before the contaminated test.
For instance, with paracetamol, we tended to buy it in the UK. It is much cheaper than here in France, so we stock up and bring it home. In the cupboard we had 9 trays of paracetamol with different batch numbers and/or manufacturers. I submitted every single batch to a lab for testing for chlortalidone. Just testing the paracetamol cost €1800. They were all negative.
I could not afford to test everything and so I submitted items for testing in batches starting with the ones that my legal team and I perceived were most likely to be the source (e.g. those which could possibly have been from the same batch I used before the test, like the paracetamol). Medications which were a secondary priority were the ones for which I didn’t have the original batch but bought a replacement from the same local pharmacies to test “just in case” it was also tainted or had the same batch number. The lowest priority were my supplements as not only had they already been batch tested, but I also knew I was taking the exact same batch during my previous (negative) test in March. In total, I did 28 tests for 12 separate medications (including those used by the dentist) for chlortalidone. All were negative. Only a few days after hearing from UKAD for the first time, I drove to Strasbourg to deliver my medication to a laboratory for testing. In order to get the medications there as soon as possible, I left home at midnight, drove through the night and arrived at 5am. I couldn’t sleep so I went for a walk in the sleepy city. Seeing otters playing in the river was the exact tonic I needed at that moment.
Right from the start, I knew that establishing the source of the contamination was going to be hard. It was 79 days after my test that I received the email from UKAD. This is not normal. The rules recommend that sample results should be returned within 20 days. Yet there are no special circumstances for athletes who find themselves searching for a contaminant they ingested 3 months ago instead of less than 3 weeks ago.
There were many occasions where my legal representatives at the time asked for extensions to deadlines because trying to trace specific batches of medications that I had used 3 months ago was so difficult. I was working flat out trying to gather information, source specific brands and batches of medication, contact pharmacies, contact pharmaceutical companies, even trying to directly contact pharmaceutical manufacturing facilities in India. All of this took time and was made exponentially more challenging by the huge delay in me being notified of the result. Additionally, I simply couldn’t afford to proceed at the pace of much wealthier athletes.
It is widely reported that Chris Froome’s defence totalled 7 million euros20. It is also reported that athletes in near identical circumstances to Froome, but with significantly lower financial resources, faced a ban21. The anti-doping system should not be discriminatory against athletes with lower financial means, but it unquestionably is.
My specific circumstances were repeatedly explained to UKAD when requesting extensions. UKAD were neither helpful, nor understanding. You will probably be surprised to learn that if an athlete wants their B sample tested, they have to pay for it themselves. £1271 plus VAT at 20%. I didn’t have many concerns about the testing process. I knew it was my sample because it contained the asthma medication I use every day and there were no issues when I provided the sample. I wanted to test the B sample because I wanted to be thorough, especially due to the extreme delay of the laboratory returning my sample and I had been advised that this particular laboratory had had a number of inaccuracies in their testing processes in the past. However, the reality was that it was a better use of my finances to search for the precise source of contamination by, for instance, getting medications tested for chlortalidone at a private laboratory and employing specialist lawyers to help me understand the process and how and what to search for.
I repeatedly explained to UKAD that due to the cost of the B sample, I wanted to continue my investigation first. If, for instance, the first batch of paracetamol I tested was contaminated, then doing the B sample would have been a huge waste of money. It is simple logic.
But not for UKAD. UKAD sent an email stating:
“UKAD considers Ms Banks position in relation to her B sample, and the investigations she is undertaking into her medication/supplements, to be entirely separate matters, and the delay in the latter should not impact upon any decision on the former.”
My legal team tried to reason with UKAD on my behalf. It did not work.
Behind the scenes I was in turmoil. Paying for the B sample would have meant borrowing money and putting more financial strain on me and my husband. Not doing the B sample didn’t seem fair and I knew I would open myself up to public criticism which I wasn’t in a position to handle at the time. We asked UKAD if specific measures could be made to reduce costs. Their answer was no. We then asked UKAD if they would contribute towards the costs. The right to a B sample is a fundamental right of an athlete as defined by both WADA and the Court of Arbitration for Sport22,23,24,25. It would appear that an athlete only has the right to a B sample if they can afford it, because, you guessed it, the answer from UKAD was no.
One of the things I found funniest, in the sickening meaning of the word, was UKAD’s sense of fairness during this process. On 29th September 2023, UKAD sent an email appearing to be frustrated by my extension requests. UKAD stated:
“EXTENSION REQUEST The original deadline for Ms Banks to respond to UKAD’s Notice Letter was Monday 7 August 2023. That deadline has now been extended by UKAD on numerous occasions, at the request of Ms Banks, by a total of 51 days. Including the ten-day period that Ms Banks was originally given to respond, she has had approximately two months to finalise her response.”
It is apparently perfectly acceptable for me not to be notified of my test result for 79 days with no consequences to either UKAD or the laboratory. However, when I am trying to locate a contaminant far smaller than a single grain of sugar that was consumed over three months ago (remembering that my life and future rests on it), UKAD implied that it is not reasonable for me to take 51 extra days to look for it (two thirds of the amount of time between my test and receiving the result).
In fact, when you learn that the urine test which detected chlortalidone was undertaken by the laboratory on the day following collection (12 May 2023), it is incomprehensible that no party acted immediately. UKAD did not request that I was promptly tested again to confirm if this low concentration was due to contamination. Neither did they give me a heads up to keep all my medication, food and drinks and provide an immediate list of everything I had done. Everyone waited. And while they waited, everything became exponentially harder.
Running on empty
After a few months I couldn’t even look at my bike or kit anymore. I couldn’t ever imagine wanting to use it again. I took up trail running which both helped to fill the cavernous hole that cycling had left and usually helped to clear my head. But there were also those days where I could think about nothing else and I was just running in my own echo chamber of torture.
In July 2023, I considered myself to be in a comfortable position financially. My husband and I both had an income, we had what we considered quite a lot of savings and we were incredibly fortunate not to have to worry about day to day expenses. The reality is that most athletes do not have the resources to even begin to defend themselves in a process such as this. It is a human right to have a fair trial and this process is inherently unfair.
Less than 3 months after notification, I had spent in excess of 38,000 euros investigating this case. That included every penny of savings that my husband and I had accrued as well as money borrowed from both mine and my husband’s family. These costs barely scratched the surface of the initial investigation. Furthermore, I was no longer receiving an income due to the provisional suspension which compounded the financial and emotional stress. I was advised that taking this matter to a tribunal (which was, at the time, the best chance of reducing the ban from two years) would cost me around £100,000. Given that I have spent at least 1500 hours on this case, I believe that estimate is much less than it would have actually cost to get the same outcome if I hadn’t had the good fortune and specific knowledge to be able to fight this process myself.
I was so close to packing it all in. I was repeatedly told that if I didn’t find the specific source of contamination, for example by a particular product returning a positive result after lab testing, then I wouldn’t get a reduction in ban. So what was the point then? Even if I did have hundreds of thousands of pounds. It would just be more time, money, and stress for nothing.
I knew already that professional cycling was over for me. Even if I wanted to go back, I didn’t think I ever could because of how damaging this has been and the way it has destroyed my husband and me. I could not risk putting us both through anything like this again.
I still had the perpetually sickening feeling that my life was over. My mental health had been ripped to shreds. I consistently felt that I had lost everything, that I would never be able to work due to my name being tarnished, that when the world and the cycling community finally found out I would be labelled as a doper and discarded by all those who I thought cared about me. That I would lose my integrity which is so deeply entrenched in the core of all my beliefs and actions. This is one of the things that hurt the most. I became deeply depressed. Over the months, it worsened and I started to have suicidal thoughts. It was terrifying for me and deeply harrowing for my husband. After reaching crisis point multiple times, I eventually sought the help I so desperately needed. It wasn’t a quick fix, it never is, but I am genuinely thankful to my psychiatrist and most importantly to all my loved ones who supported me so unequivocally that I am still here writing this today. In truth, I don’t know if we will ever fully recover from the deep scars this process has left.
What this had done to us was the one reason I knew I had to continue. I knew I had to fight this with everything I had, for all those athletes who didn’t have the good fortune of good education and an incredible network of support like I have had. For those without the financial resources. For all those whom this process has torn to shreds. I owed it to all those athletes past, present and future to do everything in my power to change the system. I truly believed that if I couldn’t do it, no one could.
*Excuse me whilst I take a break to have a quick cry*
I decided to fight. To fight to incite essential positive change. I could no longer afford legal support and my formal representation from Morgan Sports Law ceased. But I cannot say thank you enough to them. Getting to this point without them would have been impossible in a system which works so fiercely against protecting athletes. Morgan Sports Law also continued to help me on an ad hoc pro-bono basis. Although I did all of the substantive research and written work myself, their support and legal guidance was invaluable and I have to personally thank Sam Comb who worked on my case and gave up so much of his own time to help me. I am really incredibly grateful.
By this point I had read the WADA Code inside out. I was convinced to the letter of the rules that I should very clearly not be facing a ban. There are various sanctions that can result from a positive test. I was unequivocal in my belief that I should be given a finding of “No Fault or Negligence”. The WADA definition is as follows:
“No Fault or Negligence: The Athlete or other Person’s establishing that he or she did not know or suspect, and could not reasonably have known or suspected even with the exercise of utmost caution, that he or she had Used or been administered the Prohibited Substance or Prohibited Method or otherwise violated an anti-doping rule. […] the Athlete must also establish how the Prohibited Substance entered the Athlete’s system.”
It was clear to me that all the evidence I had presented to UKAD demonstrated not only that I took my anti-doping responsibilities very seriously, but there was literally nothing more I could possibly have done to have avoided the “use” of a banned substance. That first part was clear. Personally I don’t like the term “use” because I feel it implies knowing use of a substance, but disappointingly it is the term WADA has given to indicate how something got in to your body, regardless of the means.
“The athlete must also establish how the prohibited substance entered the athlete’s body.” Well now this is just one of the instances in which the whole system is a complete mess.
The WADA rules clearly state:
“Where the Code places the burden of proof upon the Athlete […], the standard of proof shall be by a balance of probability.”
The Court of Arbitration for Sport has consistently ruled for many years that in cases where a substance could not be specifically traced to its precise original source, that it can still be estab