Behind the Curtain

By Jim Ferstle
Welcome "behind the curtain" of the sports drug testing process. As sports doping has become more sophisticated, the methods used to catch someone who is doping have had to become better as well.  In endurance sports, such as distance running and cycling, blood doping, enhancing the blood for a performance gain, has become the "battleground."

How do you tell the difference between when someone is merely training hard, getting proper recovery and diet, or doping?  Tests have been developed to detect the use of recombinant erythropoietin(EPO), the use of which had replaced blood doping(removing and reinfusing blood to enhance the oxygen carrying capacity of one's blood.) as the method of choice for endurance athletes.

But those using rhuEPO have discovered a "work around" to minimize the danger of being detected of taking what is called "micro doses," small amounts of rhuEPO.  They combine use of the rhuEPO in micro doses with "old fashioned" blood doping--removing one's blood and reinfusing it close to a competition in order to increase your red blood cells/oxygen carrying capacity of the blood.

The reason for going back to "old fashioned" blood doping is that it is much harder to detect, especially when   the individual uses his or her own blood.  How can you tell if somebody has done a "vampire transfusion"(sucking out one's own blood and putting it back in again)?  The answer has been a protocol known as the biological passport.  Simply stated the biological passport is a comparative analysis of various blood parameters over time,  tracking and the changes and .interpreting what those changes mean.

Detecting use of rhuEPO is a simpler process.  Scientists developing the test discovered that the recombinant(synthetic) EPO was different than the EPO produced by one's body.  (EPO is the body's natural "trigger" for stimulating the production of new red blood cells--reticulocytes.) Thus, using a process called electrophoresis, synthetic EPO could be differentiated from the EPO everyone produces normally.

So, the "sophisticated dopers," those who didn't merely take a PED(performance enhancing drug/substance), but used every means at their disposal to make sure the substance or method they were using had minimal danger of being detected by the current drug testing protocols.  It's been called the "cat and mouse" game, the mouse being that doper and the cat being the anti-doping corps attempting to catch them.

If you've ever watched a cat hunt its prey, you'll notice the cat patiently watching a mouse, a bird, whatever it  is after, and studying the patterns, movements of the prey.  The anti-doping scientists, to some extent, do the same thing.  They compare the physiological profiles of "normal" athletes with that of those who are doped.  Patterns emerge.  Abnormalities are discovered that allow the scientists to determine whether the individual is doping or not.

For example, the reticulocytes, mentioned above, are more plentiful in the blood of a person who is stressed in such a way that the body compensates by attempting to increase red blood cell production.  If you travel to a high altitude, for example, oxygen is less available so the body adapts by producing more red blood cells.  You can artificially attempt to do this by getting an injection of rhuEPO, which will quickly increase your red blood cells, but the body also has a feedback mechanism, a governor, that recognizes that this sudden increase in EPO is not part of the regular process.

It is an artificial, short term enhancement that, if continued, will overload the blood with red cells, creating thick blood and potential negative health effects.  So the body shuts down its production of reticulocytes to slow the increase in red cells.  So, injecting rhuEPO into an otherwise healthy individual leaves a tell-tale indicator of artificial enhancement, a lower retiuculocyte count, fewer young red blood cells.  Since red cells stick around in your body for months, you get a mixture of "old" and "new" red cells.  This mixture is one of the indicators that someone has artificially attempted to produce more red cells instead of a natural body adaptation of producing a "normal" level of red cells.

This analysis of biological fluids and changes is complex, an interconnected cascade of reactions and substances.  Each individual can be different.  Thus the data required to differentiate between those who are cheating and those who aren't is not as simple as merely finding a substance, such as rhuEPO, in an athlete's body.  What the discussion between the two sports scientists--Robin Parisotto and Michele Ferrari--that we've had here over the last few days is about is the interpretation of biological passport data.

It gives you a peak behind that "curtain" of discussions that go on every time an abnormal profile shows up on doping tests/athletes' biological passports.  Recently Mario Zorzoli and his colleagues at UCI(Cyclings world governing body) published a paper that did a similar analysis of some of the cases that UCI has seen using the biological passport.  Some athletes were found guilty, others not.  The paper illustrated the complexity of the "cat and mouse game," of determining who doped and who didn't.

And none of this addresses the legal issues that come after a scientific panel has ruled that a case they have examined should be prosecuted as a doping violation.  This peak behind the curtain is not the final word in this sort of situation, it's merely a peak at how these decisions are made, the arguments that both sides engage in during this process.  Why is this important?  Because doping is a problem for modern sport.  Not just at the elite level, but if you follow news reports of doping, you know that Masters cyclists are using rhuEPO, high school kids are using steroids.  A symposium was just held this past weekend in Stockholm tilted: "Doping as a Public Health Issue."

There is a growing number of scientists, ethicists, and sports trend watchers who believe that doping will be the norm for sports in the future.  That technology is advancing at such a rapid pace and the will to spend the money necessary to police doping is seemingly not very strong, so sports, especially at the professional level, will be more about entertainment than the games.  In the future, they believe, genetically gifted, maybe even engineered, athletes will display their talents for the public's amusement.

Whatever the future, what we can learn from the past is that doping has been largely ignored until recently and has grown as an industry and as a means of achieving success for aspiring athletes.  We can sit by and watch as that trend continues or learn about the issue.  Peak behind the curtain and see what is happening and learn more about what needs to be done about it.  The choice, as always, is yours.