Journalism in the Public Interest

Elite Runner Had Qualms When Alberto Salazar Told Her to Use Asthma Drug for Performance

"I don't think our sport is a lost cause, and I want to be part of the movement making it better," Lauren Fleshman said. Above, Fleshman celebrates a victory in the 5K in 2006. (Messerschmidt/Getty Images)

Over the past two weeks, ProPublica and the BBC have reported allegations from professional runners and their support staff that iconic coach Alberto Salazar — head of the Nike Oregon Project and coach of the 10K gold and silver medalists in the last Olympics — violated anti-doping and prescription drug regulations. Salazar has denied the allegations.

Elite distance runner Lauren Fleshman says that Salazar helped her get treatment for asthma, but she became squeamish when he suggested that she use medication in a different manner than the doctor instructed. Fleshman, 33, won five NCAA titles while at Stanford University, and won U.S. titles in the 5K in 2006 and 2010. She is a prominent figure in American running, not only by virtue of her on-track accomplishments, but also because she coaches, writes "The Fast Life" column for Runner's World, is active on social media, and co-founded two businesses related to training and health.

Fleshman was previously part of a Nike-sponsored team, but was never coached by Salazar. She spoke with ProPublica reporter David Epstein about her experience seeking medical help from Salazar.This conversation has been edited for length and clarity. (Listen to the full interview below or on Soundcloud.)

Alberto Salazar has never coached you, but you did go to him for some medical help. Can you tell us what it was?

In 2005, I started having worse symptoms of exercise-induced asthma. I had gone to an allergy and asthma doctor on my own, and I got tested after the season was over in 2004 and didn't fail the asthma test. The environmental triggers [like pollen] weren't there. [The doctor] was like, sorry, you don't have asthma, you can't get a prescription.

Alberto set up an appointment in Portland, during allergy season, with a doctor who had seen many other runners. He had a specific protocol ... you would go to the local track and run around the track, work yourself up to having an asthma attack and then run down the street, up 12 flights of stairs to the office and they would be waiting to test you. So that's what I did and I failed the test, and the doctor prescribed Advair for during the racing season when pollen counts were the highest, and albuterol, which is a rescue inhaler.

Alberto was actually really great; he was instrumental in helping me get the appointment, taking me to the appointment ... I was a Nike athlete; I wasn't his athlete, but I was a Nike athlete, and to him that was enough.

How was the appointment?

When I left is when I felt uncomfortable. The experience didn't leave me not liking Alberto; I actually really like Alberto. After I got the medication, he explained to me that this is going to be great for you, so many athletes once they got on this, did so much better than they'd ever done before. And he described the ways that could happen: there's a glucocorticosteroid in [Advair], and there's a possibility that some of that could get systemically into your body and give you an advantage, and you can legally take it because you have asthma ... He encouraged me to push to be on the highest dose of it year round, which was something different than what the doctor had said.

There was this whole other level it seemed of how to use the medication, and it made me feel uncomfortable because it was clear to me that, well maybe there is some kind of advantage to this and how do I feel about that now that I have this medication. Is it ok? I guess legally it's ok. Alberto is saying it's ok ... It took me a while to process that.

Alberto and the doctor had different ideas of how you should use the medication, right?

There were three dosage levels of Advair ... and the highest one is for extreme situations. So when I came to the doctor I was really flared up ... so he didn't think it was a bad idea to start with that to calm things down, then the idea was to change to something lower ... because there are side effects to those medications. But Alberto very clearly pointed out that he felt the glucocorticosteroid could have a positive effect, so why not take the highest dose. And he didn't really talk about side effects or anything. I looked that stuff up on my own later, because I got thrush, and it also gave me kind of bad breath, from the thrush ... That really took me by surprise, but he didn't really seem worried about any of that stuff.

And what about in terms of the times of the year that he wanted you to take it?

The doctor said to take it during pollen season, which overlaps with peak competition season, and then to either not take it the rest of the year or phase it down to the lowest dose.

And Alberto?

His recommendation was to take it year round.

And in terms of the method of administration, could you explain a little bit about Alberto's suggestion?

The doctor told me breathe it in my mouth, hold it for 10 seconds, and then breathe out normally. And Alberto said to breathe it in, hold it, and then breathe it out your nose slowly, because then you expose the glucocorticosteroid to the nasal passages as well. And the theory is if it's supposed to open up your passages, then it will open up your nasal passages too, and make sure that every single passage the air could come down is maximally opened.

Whose recommendations did you follow?

At first I followed Alberto's, and I was on [the highest dose] ... And then, this is going to sound so dumb, but I got this educational pamphlet in the mail from USADA [the U.S. Anti-Doping Agency], and it was talking about clean sport ... and you have to take this test that shows you have an understanding of the rules and the purpose of USADA and clean sport and all this stuff.

There was just something about it that made me feel very clearly that that approach to my inhaler was wrong, that the spirit of the sport did not support that. Turning illness into an advantage was not right. That you take a medication to fix the problem, not to fix the problem and then go above and beyond. I don't even know if the medication really does that ... The inkling I'd had in my stomach in that first conversation with Alberto just felt stronger. I wouldn't feel comfortable telling people, publicly sharing that I'm taking the highest dose of this, so maybe that's not right.

Fleshman said she began to feel bad about the situation.

There were other things that happened later that kind of reinforced that that asthma experience had started to take me down a path that I didn't want to go. That's the main thing that motivates me to tell this story at all ... the way my interactions with Alberto made me feel ... something changed in me where I started to feel like the TUE [therapeutic use exemption] system was something to work around, that it was ok to look for loopholes and this is just kind of the American way. Maybe we're not born in Africa and we don't get raised at 8,000 feet elevation, and have long stick legs and extremely light frames to fly around the track, but we're in the most medically advanced country ... So there was this part of me thinking maybe this is just the way, maybe there is a way through medicine and TUEs ... And it felt dangerous.

Fleshman said she later called Salazar for help with another training aid.

I called up Alberto when I heard people were turning their apartments into altitude apartments ... and he came down and set it up to have it installed in my apartment, and I was sleeping in an altitude apartment.

I was unable to handle the training load that I'd been able to handle without any problem for the past few years. I wasn't resting at night; I was restless ... because of the altitude ... And I'd heard some of his athletes had seen this doctor and they had suppressed thyroids, and I knew these athletes slept in altitude tents too. And I was like, oh man, well maybe that's the problem, maybe my thyroid is messed up and maybe — instead of looking at it like the altitude tent messed up my thyroid — maybe it's something about my thyroid is insufficient to handle this altitude tent. You can see there's a different in that mentality, right? I felt like somehow I deserve to have some superhuman thyroid that can handle anything. So I talked to my coach, Vin Lananna: I think my thyroid is suppressed. He said that could very well be it, you're not responding to the training anymore, you're tired all the time. And I was like people go to this doctor, Alberto knows about him and I'm thinking about reaching out. And this was the most embarrassing moment, but the really important turnaround for me: my coach looked at me and he goes: "Ya know, you could do that, and if you want to do that, it's your career, and I don't think there's necessarily anything illegal about it, but the reason why your thyroid is as messed up as it is because you're not resting enough, you're sleeping in an altitude tent, and you're training too hard. And you have to back off, you have to change those things, you have to take responsibility." And that made me so embarrassed that I was thinking the other way. I had almost been unconsciously scheming like, oh, cool, if my thyroid's suppressed I'll be able to get on thyroid medication, great, and that will have other advantages. It was like this idea of turning illness into advantage again, even if you are the one who causes your own illness.

Now, I definitely do think that's an ethical violation ... So I just hope more people talk about their experiences, because if we can talk about them, we can decide how we feel about them ... [Aside from drugs] there are also methods that are banned, and I would like to see those methods expanded to abuses of the TUE system, and to looking at illness as advantage. I think that would be a huge win for clean sport.

The discussion seems to be happening very openly in track right now, more than I've ever seen in any sport.

It makes me really proud to be a track and field athlete when I see athletes coming forward like that. And I really do believe the majority of track and field athletes are playing clean ... And so I guess, technically, maybe Alberto's stuff is clean with the exception of the testosterone, if that ends up being true. The things I really care about are more of these ethical questions of how TUEs are used. The reason why I think athletes are coming forward in this unprecedented way is because of how it makes you feel. When you decide to go that route, to take this aggressive medical approach, you feel gross about it ... I think a lot of these people will look back 10 years from now like, those things are not ok.

When you have a coach as powerful as Alberto Salazar, he's now attracting the country's best youth ... we're talking teenagers. And he's responsible for instilling in them what it means to be a professional athlete ... I am extremely uncomfortable thinking of him coaching a Mary Cain. I get uncomfortable around anyone in an Oregon Project uniform even if they're not doing anything wrong ... And I could've been coached by Alberto Salazar, the door was open. In the end I didn't go there because I knew I would have to police myself.

Fleshman said watching other athletes come forward inspired her.

I just can't not say something when people like Kara Goucher come out and puts her face to her words, and Steve Magness, and other people that have things to lose ... and [former Oregon Project runner Josh] Rohatinsky is the one that put me over the edge because I really respect that guy ... I don't think our sport is a lost cause, and I want to be part of the movement making it better.

Rohatinsky didn't have any particularly bad experiences, but felt there was a wall between what goes on with Galen Rupp and other people, and said he believed the "full extent" of all the allegations we reported, including faking symptoms to acquire a TUE, and Salazar testing testosterone on his son. What do you think?

I would say the same. The [Steve Magness account of] the book and the pills seems a little crazy to me ... but I don't see any reason to doubt Steve Magness at all. The other stuff, absolutely ... I think [Salazar] looks at the TUE system as the obstacle in the way, and it's not anything to be taken super seriously. It's the same thing with the handing out Celebrex or those other stories, those don't surprise me at all.

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