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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 28^th 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

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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.

On 28^th 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.

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.

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Overview

Since 28^th 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.

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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.

From 28^th 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.

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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. 

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A short history of contamination

Prior to 28^th 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.

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.

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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 levels^5,6. 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.”

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WADA letting the cat out of the bag

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:

“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 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“

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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.

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.

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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.

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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.

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 drugs¹⁶.
• At one firm, direct and indirect contact surfaces had not been cleaned or examined for cleanliness since installation over 14 years ago¹⁷. During the inspection, residue samples were collected at the end of placebo batches and subsequent cleaning, which also demonstrated active ingredient cross-contamination on surfaces¹⁷.
• 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 them¹⁸.
• 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.

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My search for the contaminant and exhaustion of my resources

My previous anti-doping test was two months prior on 14^th 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.

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 Sport^22,23,24,25. 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 29^th 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.

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Running on empty

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 established on the balance of probabilities how that substance entered the athlete’s system^{7,26,27,28,29}.

UKAD didn’t argue that the chlortalidone use was intentional. I understand from both emails and many phone conversations that at no point did UKAD believe either that I had “used” chlortalidone intentionally, or that I had actually ingested a pharmacologically effective dose. Yet UKAD’s key argument was that the burden of proof lay on me to rule these scenarios out.

UKAD’s argument made no sense. I had presented UKAD with a huge amount of scientific evidence, documentation, research and caselaw as well as incredibly detailed written submissions (my final submissions were 144 pages and over 42,000 words). These documents demonstrated that not only was pharmaceutical contamination evident on the balance of probabilities, but it was beyond reasonable doubt. Given the content of my submissions, UKAD’s argument was also contradictory to the manner in which the Court of Arbitration for Sport have consistently ruled.

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Positive test for formoterol

You may be thinking, all this talk of chlortalidone is all very well, but why did you also test positive for formoterol? That is an excellent question.

My sample tested positive for 2.9ng/ml of formoterol. Formoterol is a medication I take as part of an inhaler called Symbicort. I have been taking this medication since summer 2020. It is listed by WADA as a threshold substance, meaning that it is allowed to be present in urine up to a concentration of 40ng/ml on the basis that it was likely the result of permitted therapeutic use. I have never exceeded the allowed daily dose of formoterol and I have written evidence documenting my care with this.

Although the WADA rules state that formoterol is allowed up to 40ng/ml³⁰, the problem is that the WADA rules also state in conjunction with a diuretic that ANY LEVEL of formoterol is considered an AAF³¹. As it stands, the two WADA rules currently contradict each other. UKAD were supplied with all the evidence of my longstanding use of formoterol, my clinical diagnosis for asthma, my adherence to the anti-doping rules and my prescriptions for the inhaler. My position was that the AAF for formoterol should have been reported by the laboratory, but it should then have been discarded once it had been established that it was for medical reasons well below the limit for permitted use. It is both unfair and illogical that an athlete subject to a contamination event with a diuretic should have an AAF for a medication they take to treat a chronic health condition.

This is where it gets really silly.

UKAD commissioned a scientific expert to examine my case. UKAD’s expert’s conclusion in full regarding formoterol is that:

“CONCLUSION

It is my opinion that the AAF for chlortalidone scientifically should not generate a second AAF for an estimated 2.9ng/ml of formoterol.

Hence, in my opinion, it is highly unlikely that the combination of the formoterol and chlortalidone (diuretic) in the Athlete’s Sample indicates that the substances were used together in order to produce the effect the provisions of the Prohibited List is attempting to prevent.”

Having read the opinion of UKAD’s own scientific expert, I was quite sure that UKAD would indeed throw out the Anti-Doping Rule Violation (ADRV) for formoterol as it was so blindingly obvious that it was used within the rules and for medical reasons. Surely an athlete can’t be directly punished for having a medical condition?

UKAD did not throw out the formoterol ADRV.

UKAD did state that they accepted my evidence regarding my prescription and how I had used formoterol around the time of the sample. However, in an even more baffling turn of events, UKAD ignored the conclusion of their scientific expert and alleged that I had therefore “committed” Anti-Doping Rule Violations for both the “presence” and “use” of formoterol.

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UKAD’s submissions. Are UKAD fit for purpose?

On 27^th March 2024, UKAD sent me their written submissions. Given the detail, research and abundance of scientific evidence I had presented, what could they really say? I didn’t think it would take long to read UKAD’s submissions and write my response.

How wrong I was. UKAD’s response was both incomplete and misleading. It was strewn with factual inaccuracies. At two critical points, UKAD misquoted me and stated it as fact. They then went on to use this as evidence for why I was both at fault and why in their opinion (and they wrongly stated this was my opinion too), I had not established the source of chlortalidone. UKAD’s statements were manifestly untrue and completely unacceptable. I was genuinely shocked that a professional organisation produced such a poor quality document in such an important situation.

One of the most worrying things (of which there were many by this point) was that UKAD demonstrated that they had so little scientific understanding of what was an inherently scientific process. UKAD stated that I had not provided pharmacokinetic evidence. This was simply untrue and I referred UKAD back to numerous pages of pharmacokinetic evidence I had provided, graphs I had made and scientific studies I had referenced.

More importantly, it was indicative of the fact that UKAD as it stands is simply not fit for purpose. If UKAD cannot understand basic scientific concepts, it is simply not possible that UKAD should hold such a position of power over athletes’ futures in anti-doping proceedings.

Even aspects in which one would imagine UKAD lawyers really should be experts, such as referencing caselaw from the Court of Arbitration for Sport, was also a shambles. UKAD referenced a quote that did not exist and referenced a myriad of cases in a manner which was highly inappropriate to my case and the points they were trying to make.

In order to try to discredit the impact of the 79 day delay, UKAD used a argument which was a carbon copy of WADA’s argument in a case with a 44 day delay which was held before the Court of Arbitration for Sport³².  I would imagine that UKAD knew that this was the exact argument that WADA had used, and therefore UKAD should have also known that the court found WADA’s argument not to be compelling and in fact rather worrying.

I was not only shocked, upset and disheartened by UKAD’s written response, but I truly felt that responding to UKAD was a huge waste of both mine and the tribunal panel’s time as I sought in the main part to repeat and correct facts that had already been thoroughly and carefully presented.

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The hair test and UKAD’s complete 180

Due to a recent number of chlortalidone positives at contamination concentrations, two separate anti-doping scientists had very recently undertaken studies examining chlortalidone in hair. One study compared the concentrations found in an athlete’s hair (who alleged contamination) with a patient undergoing daily treatment. The results showed 2pg/mg (athlete hair) compared to 824pg/mg (daily treatment)³³. The second study recreated a contamination scenario with two volunteers. The subsequent hair tests detected chlortalidone at levels of 0.78pg/mg and 4.2pg/mg³⁴.

I was also aware of another recent case in which hair testing provided important evidence to demonstrate that an athlete had not intentionally used chlortalidone and proved it was due to contamination. UKAD argued that my failure to perform a hair sample analysis prevented me from demonstrating that my positive test was inadvertent like in the recent case above. The simple reason that I had not previously undergone the hair sample analysis was because I was told that a hair test would be in the region of €3-5,000 and I didn’t have enough money earlier in the process. Additionally, I was also previously advised that even if I did the hair test and it showed contamination, I would still need to find the precise contamination source. That argument always seemed illogical to me but as I hope you have learnt from this article, anti-doping organisations do not have entirely logical systems.

In addition to the financial implications of the test, I also felt very strongly that the rules were clear and pharmaceutical contamination had been proven on the balance of probabilities. Therefore, the hair test was not necessary. Why should I have to spend thousands more? In the end, my hands were tied. I did not want to risk losing this case after all this work. It was now only two and a half weeks until the tribunal. My hair sample had been taken in August and kept at a laboratory during this time and I asked the panel for special permission to have my hair submitted for testing at this late stage.

UKAD first responded stating that they did not object to me doing the test, but that providing the extra evidence would make no difference to the way UKAD proceeds or puts its case. This was a bizarre statement as UKAD had also submitted just the day before that it was the hair test itself that distinguished my case from another case when establishing the source on the balance of probability.

I provided UKAD with the hair test results. Unsurprisingly, the hair test indicated low level contamination in a short period just preceding my anti-doping test (4pg/mg, the same result as one of the volunteers in the contamination study³⁴⁾. Before and after that period, there was zero chlortalidone in my hair.

Surprisingly, however, after stating that provision of this evidence would not change UKAD’s position, UKAD did a full 180. In fact I don’t even think that accurately describes what happened. They sort of spun themselves round in circles and sheepishly walked backwards. UKAD no longer wanted to take the matter to a tribunal hearing. Instead, they wanted to agree what is essentially a settlement.

UKAD told me that after everything, they found me to bear No Fault or Negligence and therefore would be subject to no sanction and no period of ineligibility.

What?

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No fault or negligence offer

When I got the call from UKAD confirming their “offer”, I think I actually laughed. Sometimes situations are simply so outrageously ridiculous you either have to laugh or cry. I was standing by the window on the phone. My husband was sitting on the sofa listening. I calmly replied to UKAD’s lawyer with something akin to “so after 9 months of me repeatedly stating the same thing you’re finally admitting that I was right all along.” My husband was not so calm at this point. He sat with his head in his hands in utter desperation.

Please do not misunderstand this. This was in fact an excellent result as I will shortly explain. But for UKAD to turn around and effectively say, oh yeah no worries, you were actually right all along, was simultaneously agonising and heartbreaking after what we’d been through. I was ready to fight for my life at the tribunal in front of a panel of experts. It was almost an anti-climax. Yes, I was getting the result I deserved, but there was no understanding from their side of what this had cost, there were no repercussions for UKAD and their actions throughout this process. They didn’t even say sorry.

Part of UKAD’s terms for agreeing no sanction were that I would accept No Fault or Negligence for both the chlortalidone and the formoterol. I discussed this on the phone with UKAD. I was told that UKAD had discussed this matter with WADA and that UKAD knew that WADA would appeal the decision if the formoterol AAFs were thrown out. I wasn’t happy about this. I felt that I had been forced into a corner into accepting that I had “committed” Anti-Doping Rule Violations for an inhaler I am prescribed to treat asthma. It was both upsetting and distressing to be penalised for maintaining my health.

But I also knew that this would be a landmark case and the implication that having a national anti-doping organisation like UKAD make a decision like this without having traced the specific contaminant was huge for other athletes in my position. Although I believed that I could achieve an even better personal outcome if I continued to take this matter to a tribunal, I had to remind myself that the reason I was doing this was to try to incite essential positive change. This result as it stands has the potential to drastically change outcomes for athletes in the same situation as me.

Part of UKAD’s conditions for agreeing this finding and therefore not going to a tribunal was that the costs would “lie where they fall”. This meant that I would not recuperate any of the costs that I had borne, well over €40,000 by now, not including the salary I lost whilst I was provisionally suspended last year and the work I had put into this case. I tried to fight it but UKAD would not budge.

The only condition which UKAD accepted from my side was that the “reasoned decision”, the document which UKAD would publish to explain how they came to their finding, must be made publicly available so that other athletes in my situation could use it to support their cases. I requested that UKAD include a list of points in their reasoned decision that were incredibly important to me and which were the focus of my submissions but UKAD would not give me written assurances. I felt it was important that both mine and UKAD’s arguments were justly and fairly represented in the “reasoned decision”. It needed to be both sides of the story.

When the reasoned decision was issued, most of my key points were missing. I asked UKAD to make alterations to include these points. “After careful consideration of all the points you have made”, stated UKAD, they proceeded not to make a single amendment regarding my key issues.

In addition, I made one further request. The opening paragraph of UKAD’s reasoned decision stated only that I had “committed violations” and not, critically, that I had been found not to be at any fault. I asked UKAD to include this critical piece of information at the top of their reasoned decision. The reason why is below, exactly as I wrote in my email to UKAD.

“On a human level, I sincerely hope that the personnel deciding whether or not to make this addition consider the emotional impact directly and indirectly (through public assumptions) on the Athlete both in my case and in future cases. I would like you to imagine what it’s like to go through 9 months of absolute hell as well as losing your job and income, having no ability to get another job and spending these months fighting for your life, metaphorically as well as literally at times. After going through that I would like you to then imagine that the document issued to clear you simply introduced itself by stating you have “committed violations” without any further context. I can tell you first hand that this is incredibly painful and damaging to read and I implore you to make a small change which may just make a very big difference to someone’s life.”

I was quite surprised, yet very pleased that UKAD did actually decide to incorporate this critical change to the introductory paragraph to state that I was not at fault and therefore had no ban. I guess if you keep knocking long and hard enough, eventually someone will open that door. This small change felt like quite a big win for both me and all athletes to come.

Reading UKAD’s reasoned decision was a peculiar experience. Points UKAD had previously stated to try to discredit my argument in their written submissions to the tribunal panel were suddenly flipped on their head and used to make themselves look competent. I couldn’t quite believe that the same written correspondences came from the same people at the same organisation just a few weeks apart.

UKAD previously stated that my case was not “unique” and that it bore none of the hallmarks of specific caselaw that I had referenced. As mentioned before, UKAD stated I had not provided pharmacokinetic evidence and that I had not established the source of chlortalidone.

However, here are some particularly curious snippets from UKAD’s reasoned decision which will shortly be available to read in full on UKAD’s website:

“The unique circumstances of this case, together with the compelling scientific evidence submitted by Ms Banks, mean that UKAD accepts, on the balance of probabilities, that chlortalidone entered Ms Banks’ system through a contaminated pharmaceutical product.”

“UKAD notes, as per the scientific literature highlighted by Ms Banks, that the contamination of pharmaceutical products by diuretics is not uncommon. It is also notable that any Athlete choosing to use a diuretic to lose weight, or act as a masking agent, would be unlikely to choose chlortalidone over other diuretics due to its extremely long half-life. This is particularly relevant in the case of Ms Banks, who studied medicine for a number of years before becoming a professional cyclist, and who demonstrated throughout her evidence and submissions (as an Athlete not legally represented after this matter was referred to the NADP) a thorough understanding of the scientific issues relevant to this case.”

“UKAD notes the extensive efforts Ms Banks made in submitting the substances in her possession for scientific examination, and the wide-ranging attempts made in tracking down the same batches of medication she had ingested prior to notification. In total, Ms Banks submitted 12 different medications for testing at an independent laboratory, leading to a total of 28 separate substances being tested.”

It was mind-boggling to see UKAD acknowledging the depth of research and scientific evidence I had presented and my backbreaking efforts to trace the source. I sat reading it with my jaw almost on the floor. So many months later, UKAD were finally conceding that everything that I had said was true. So why on earth had they previously put so much effort into trying to discredit the science I had presented and the actions I had taken?

Contrary to UKAD’s statement, the fact that I had studied medicine was not “particularly relevant”. For the most part, I had just stated a series of scientific facts. As long as those facts are correct, it shouldn’t matter who you are. The crux of the matter is whether the personnel at UKAD can analyse science presented to them and deduce whether it is accurate. From my experience of working with UKAD, I can only conclude that they cannot.  

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Human rights

Right at the heart of this matter is a profound issue regarding what I perceive to be a fundamental breach of athletes’ human rights. It is likely that WADA will simply state their rules are compliant with the European Convention on Human Rights, as per the legal opinion of Judge Jean-Paul Costa who answered specific questions from WADA relating to what is now the 2021 WADA Code.

However, Judge Jean-Paul Costa conceded that only a few years ago the “Lex Sportiva” (sports law):

“was somewhat in a vacuum in relation to human rights; today these two parallel worlds have intersected and in my opinion this development is and will be irreversible. The fight against doping and fundamental rights is reconcilable and must and can be reconciled.”

The Universal Declaration of Human Rights states that:

“Article 23: Everyone has the right to work, to free choice of employment, to just and favourable conditions of work and to protection against unemployment.”

“Article 25: Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care(…)”

To the best of my knowledge, the issue concerning pharmaceutical production, Good Manufacturing Practice rules and the complete mismatch with the WADA zero tolerance rules have not been debated in the context of human rights in either a human rights court or the Court of Arbitration for Sport. It is clear that the WADA rules do not currently protect athletes who take medication from the inherent contamination risks.

My theory is that WADA are aware of the scale of pharmaceutical contamination and how there is a discrepancy between pharmaceutical rules, the ever-increasing sensitivity of testing and WADA’s zero-tolerance policy. I believe that the problem is that if WADA openly admit that this discrepancy is an issue, it would be impossible for WADA to maintain that their own rules (as they stand) conform with fundamental human rights and the whole system risks falling apart.

To be clear, I have absolutely no intention to try to “bring down” WADA or any of the national anti-doping organisations, I am just desperate for them to wake up to the issues that are smashing athletes in the face left, right and centre. I do believe that there is a way that the WADA rules can reconcile these issues and provide a system whereby the drug cheats will get flagged and caught, but the innocent athlete who is unfortunate enough to have a contaminated pharmaceutical or drink contaminated water does not have their life of hard work unceremoniously stripped from them.

From the battle that I have been going through, it has become clear to me that WADA are not willing to listen to or reason with anyone. WADA seem so preoccupied with defending the status quo that they can no longer see what is right and what is wrong, where the problems lie and how to fix them. I’m sure that additionally WADA are probably highly underfunded. However, for UKAD and WADA, the last 9 months has been a grand old waste of time. If only they had looked critically at the facts right from the start, a lot of time, money and heartache would have been saved. So, WADA and UKAD, how much money would you save if you stopped going after people like me whose cases are so blatantly clear? Perhaps you could actually spend that money on doing some informed research, changing your rules to reflect the science and going after the athletes who are actually trying to cheat instead.

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Closing statement

On the evening that UKAD confirmed that a No Fault or Negligence agreement had been made, I received an email from UKAD confirming the immediate lifting of my provisional suspension. On 11^th April 2024, the email read:

“UKAD provisionally suspended you from all sport on 28 July 2023. As far as UKAD is aware, you have respected the terms of your Provisional Suspension. As there is no asserted period of Ineligibility in this matter, your Provisional Suspension is now lifted.

You are free to return to sport as of the time of this email.”

Crikey. “You are free to return to sport as of the time of this email“. I hadn’t seen it coming and that sentence hit me hard. It was a few days before the Amstel Gold Race. Did UKAD imagine that I would just pop straight back in to the peloton? How could they? I had lost everything.

I was almost disappointed that I didn’t get to battle it all out at a tribunal. I knew that all the evidence I had meant UKAD had no chance and with the tribunal only days away I was all fired up and raring to go. I had already written the final part of my closing statement for the tribunal which discussed the case of Jack Burke. Since 2021, the UCI have had a 20ng/ml minimum reporting limit for the diuretic that was detected at 1ng/ml in Jack’s sample. Jack continues to go through hell because of WADA’s ignorance of the issues. The matter below is at the heart of why I am so determined to make a change. 

Despite being shown to bear No Fault or Negligence by the Court of Arbitration for Sport and despite having a hydrochlorothiazide contamination at a level which now wouldn’t even result in an AAF, Jack Burke’s life continues to be affected. He receives hate mail and messages on social media continuing to accuse him of doping. Getting an “award” of No Fault or Negligence is not a win. It is still a life-sentence. Especially in cycling. These rules MUST change. WADA’s policy MUST change. I am lucky. I am really incredibly very lucky. This process pushed me right to the edge of my psychological capacity. There have been many times in the past 9 months when my husband, my friends and me included were seriously concerned that this process had pushed me beyond the edge. I cannot describe the pain that we have both felt. The utter destruction of our lives, of everything we had planned for the future, despite all the meticulous care we took and thousands of hours of work we put in. So many sacrifices were made. Weddings missed. Christmases missed. Birth of nieces missed. Sacrifices which are simply not worth it when my life has been thrown away like this by no fault of my own. I cannot bear to think of other honest and hard-working athletes going through what we have been through and most critically I gravely fear that an athlete in my situation will end up taking their own life.  Precedents must be set by someone and I beg you to start here by inciting the change that the sporting world so desperately needs.”

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Appeals

Despite my provisional suspension being lifted on 11^th April 2024, I have still been unable to speak about this and truly move on as the decision was subject to possible appeal by WADA, British Cycling, the UCI or me. On 17^th May 2024, the first deadline for appeals closed. For some reason, WADA are given an extra 21 days to appeal after the initial period has closed. As of the time of writing, no appeals have been made. For my own health, I cannot stay silent anymore. I thought I was doing okay, but on 17th May, I had a complete meltdown. I need this to be over and in order to start that process, I have to make this public. I understand that by convention, if WADA want to appeal, they usually do it in the first 21 days. If WADA now decide to appeal, noting that the information is all in the public domain, you can draw your own conclusions about why that might be.

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Postscript

I understand that having read this, you may be very concerned for my wellbeing. I want to reassure you that although things aren’t perfect right now, I am in a much better place. I know that when this becomes public that I will have to digest those hardest of comments from the smallest minority of people, but I have also learnt the value and importance of the simple things in life. The support of those I care for and trust and who care for and trust me too. There became a time in this process where I learnt that whatever happens, having those people around me is simply the most important thing in my life.

I also know that this story will be a big shock to many of you. It was, of course, a huge shock to us too. Like any process of grief where one has lost something of great importance in their life, it is a slow process of recovery. I have been processing this grief since July 28^th 2023 and I am very slowly healing from it.

After retuning from the UK for the trip to the tribunal that never happened, I started using a local shared wood workshop. I have always loved DIY and creative processes and for many years I have had a dream about becoming a woodworker and furniture maker. The first days I spent at the wood workshop were simply the best therapy I could have asked for. I was absorbed in something so creative and satisfying and during my hours in the workshop the horrors of the past months temporarily faded away.

The reality is that I do not know what lies ahead for me. For the most part, I have now come to terms with that. Throughout the hardest times in my life, I have always looked for the silver linings. If you look hard enough, you will always find them. To end on a positive note, I will share with you my first 5 projects from woodworking. Three cat tables (yep, tables for cats, some things about me haven’t changed!), a toilet roll holder and a mirror made from offcuts. Hopefully I will shortly start making human sized tables too, although, and if you know me you won’t be surprised to hear this, my next project is a luxury outdoor cat house.

Thank you

To everyone who got this far, I just want to say a massive thank you. I believe that this is a very important story which desperately needs to be heard. The public need to understand what really goes on behind closed doors and what the true impact is on athletes like me. You may have noticed the Support me on Ko-fi links dotted around. I hope to be able to train as a woodworker but affording a training course is out of the question right now. If you would like to donate towards my training or you are inspired by my work to change anti-doping for the better, then any donation would be hugely appreciated.

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References

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2. WADA Technical Document TD2022DL https://www.wada-ama.org/en/resources/lab-documents/td2022mrpl↩︎
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