News: Carleton College Grad Elected to USADA Board of Directors

Phillip Dunn, a Carleton College grad and Olympic race walker, is elected to the USADA Board of Directors HERE.

Commentary: It's All About Trust

Courtesy of Clipart Panda

The latest doping scandal is grabbing headlines all over the world.  The German network ARD broadcast an hour long documentary on alleged corruption, bribes, doping, and cover ups in Russia.  Just as in the major political scandals it's not the crime but the cover up that is the core of this story.

It's all about trust.  For the anti-doping system to work, all involved have to trust that the system does what it is supposed to do.  That athletes and their enablers who cheat through doping are subject to the same laws, oversight, testing, and sanctions.  That the alphabet agencies that oversee the anti-doping process are treating every case the same, fairly, transparently, and according to the legislation in place to police doping in sport.

The major failure in the system highlighted by the German expose is the alleged collusion to protect certain athletes from punishment for doping.  In effect those who were supposed to enforce the rules became doping enablers.  This is not new, back when I first started covering the issue of doping in sport in 1987 the same flaw plagued the sporting world.  Those in charge of the various international and national sporting federations were lax in their enforcement of the rules.

Doriane Lambelet Coleman, a middle distance runner and lawyer who, along with Edwin Moses and Harvey Glance, attempted to rewrite the rules for anti-doping for the US track & field federation, now called USATF, said that the rules on the books in the early 1990s "looked like they were written by someone who didn't want to catch anybody."  There were huge loopholes, many ways to cover up positive tests, and/or allow athletes who cheated and were caught to get away with it.

The US was not alone in this doper protectionism.  The shared feeling among the sports "super powers" was that the other countries were doing it, so we have to do it.  Dr. Don Catlin, who was a pioneer in drug testing within the IOC and the US compared the situation to nuclear disarmament.  Neither side in this "war" was willing to "demilitarize," take away one of their most potent weapons, doping, because the other side would "win."

There was no belief that athletes who didn't dope could or would be able to compete with those who did.  And no trust that those who were caught by the meager drug testing program in place at the time would be punished.  As doping scandals kept erupting, the IOC knew it had to act to protect their "brand."  The anti doping system was polarized.  The labs would get positive tests only to see the athlete whose sample they tested continuing to compete and win medals in international competition.

Some of these cover ups were eventually exposed.  The scandals generated enough momentum that the IOC was forced to act.  They created WADA as an independent oversight agency charged with policing the drug testing system that, at that time didn't exist.  Over the years more alphabet groups were formed within nations to act as independent testing and enforcement agencies.  To take the countries' sports federations self interest in attempting to win medals and championships out of the doping business.  USADA, UKAD, ASADA, and all the other domestic anti-doping agencies were created to police doping in sport.

Over that time, roughly about 20 years, trust has been established that within countries with functioning agencies would not "look the other way" when that country's star athlete was busted for doping.  Athletes who doped could no longer count on sports administrators making their doping offenses "go away." The biggest problem that remained was that not every sports power had a functioning anti-doping agency.  Third World countries, such as Kenya or Ethiopia, that dominated segments of sport, such as distance running, still do not have such agencies.

So rumors and innuendo continued among athletes that the African athletes' success was due to the inability of the IAAF, the international federation charged with overseeing, promoting, growing the sport, to bring the various countries in line with the WADA Code that attempts to "harmonize" the anti-doping system.  To make sure that each country has, at the very least, an independent doping deterrent in place.  As the other current doping scandal has exposed, Kenya is not immune from the spread of doping, but in a relatively short period of time, some progress has been made in this area.

The World Marathon Majors, a coalition of major marathons throughout the world, has funded some testing in an attempt to do what the various countries and sports federations have not been able to do, provide out of competition testing in areas with no operating anti-doping agency in place to deter athletes from doping.  That the WMM has had to do this is indicative of the lack of adequate funding for the entire anti-doping industry.  When Paula Radcliffe was asked what she would do if she were in charge of the anti-doping program for the IAAF she responded that she'd triple the IAAF's anti-doping budget.

The old investigative mantra of "follow the money" as a tool for examining institutional or individual shortcomings is apropos of one of the major weaknesses of the current anti-doping system.  Chuck Yesalis, who has followed the ups and downs of the anti-doping movement over decades, has said that in the fight to minimize doping in sport the anti-doping forces are fighting a war where the other side has guns and they have pea shooters.

The most important asset for the anti-doping movement, however, is something money can't buy.  It's trust.  Trust from the public that what they are watching is not a drug riddled circus.  Trust that anti-doping agencies cannot be bought or influenced to "look the other way" because a highly marketable athlete is caught doping.  Trust that the sports federations and other groups with influence over the athletes are doing their jobs in policing doping, enforcing the rules.

Thus the current revelations about what has alleged to have been going on in Russia go to the core of the doping problem.  They undermine the trust within the athletic community that all that can be done is being done to protect clean athletes, enabling athletes to compete on equal footing, not having to worry that the athlete next to them on the starting line is pharmacologically enhanced. The anti-doping system cannot function properly without that trust.

When Ben Johnson was caught doping in 1988, Catlin thought this would demonstrate that the testing system was one all athletes could trust.  That the fact that the most marketable athlete in the then most marketable sport in the Olympic Games was busted for doping would turn the tide in the anti-doping battle.  Instead, shortly after Ben was busted a mother and her son came into a pediatrician's office in the Twin Cities and asked the doctor to prescribe for her son some steroids so he could be a better wrestler. This was not an isolated incident.  At least one message delivered by the Seoul Olympic bust was that "steroids work."

There were minimal disincentives to dope back then.  There was no WADA.  no USADA, and now that RUSADA, the Russian anti-doping agency, is implicated in the allegations swirling around the doping scandal in Russia, the anti-doping efforts will take a hit.  Some trust will be lost.  The challenge is to reestablish that trust. Without it the athletes will still be tempted to take "short cuts," to dope.  There will continue to be doping scandals.  There will continue to be parents who want the "magic potions" for their kids, and sport as we know it could morph into a modern day gladiator fest.  "Entertainment" that attracts paying audiences rather than one that celebrates and showcases athletic skills.

Athletics could become a freak show of doped up individuals, replaceable parts in a traveling roadshow, a circus of sports that makes money for the owners and operators of the franchises, but treats "athletes" like indentured servants.  Is this rather dystopian vision what we want our sports to become?
--by Jim Ferstle

Lance's Legacy

By Jim Ferstle
Lance Armstrong is a survivor.  He survived a broken home, essentially growing up without a father.  He survived cancer.  Now he has to survive a test of his own making.  The USADA's  "reasoned decision" as the file on the investigation of doping on the US Postal/Discovery teams documents has been labelled, documents in detail what has been known in the cycling community for years.  Doping was part of the culture.  It was perceived as the only way to the top of the sport and was part of the mantra: "Everybody is doing it."

Everybody wasn't doing it, but enough were to transform the sport of cycling.  The same could be said during this era about other sports, including track and field, and with the introduction of blood doping and use of rhuEPO, distance running.  At a conference on the topic of doping in sport in the late 1990s at Duke University, Alberto Salazar was one of the speakers.  He told the group that he was reluctant to encourage his own kids or anybody else's to get into the sport because it was perceived that doping was necessary to rise to the top.

In 1984, John Treacy, an Irish runner who later that year won a silver medal in the Olympic marathon and already twice won the World XC Championships, walked into a bathroom at the Meadowlands prior to the start of that year's IAAF World XC championships.  There he saw members of the Spanish team injecting themselves with a red substance in syringes.  Years later, I was at the table in a restaurant in the New York Hilton during New York City Marathon weekend with John, Minnesotans Mark Nenow and  Steve Plasencia, Steve Scott, and other top runners of the era.

Talk got around to doping, and John reiterated his own vehement opposition to the notion that you had to do it to succeed.  He knew others were doping.  He knew it was a big problem in the sport that wasn't being properly addressed by the sports governing bodies.  But that didn't make him believe he had to dope.  He derived great satisfaction, he said, by beating the runners he believed were doping.  Today John is the head of the Irish Sports Council, whose anti-doping unit polices the doping issue in Ireland.

Running has always had the advantage of being an individual sport where you won or lost based on your own talent and ability to perform.  It wasn't the sort of team effort or culture where others could be pressured to give in to the temptation to dope just to keep one's "job" or stay at that level of the sport.  The pressure to dope just to survive wasn't as intense, yet, as the recent case of California runner Christian Hesch  illustrates, doping can be a strong temptation not only for Olympic level athletes, but for others as well.

Hesch only came forward with a confession of his guilt for using rhuEPO after he was caught by teammates who threatened to turn him in to USADA.  Armstrong missed his first opportunity to join the other cyclists who admitted their use of drugs and accept a more lenient punishment by helping the agency attempt to get at the roots of the problem, the suppliers, enablers of doping that make the practice possible.  Thomas Bach, and IOC VP, has urged Armstrong not to miss another, to "come clean,"  to essentially be part of the solution to the doping in sports cycle instead of part of the problem.

When Armstrong got cancer he devoted his considerable energy and determination toward dealing with his illness.  Then he took one step further by trying to be part of the solution to the curse of cancer.  Nobody expects him to confess.  To tell all he knows about the dark underbelly of sports. But it would be, perhaps, a greater achievement than finishing first in the Tour de France seven times.  If Lance Armstrong wants to be remembered for what he did for sport, he has a chance to step up and be remembered not as what Greg LeMond has called the sport's greatest fraud, but rather as someone who contributed to changing the course of modern sport.  If he wants to be remembered for the good he has done or forgiveness for the damage he's caused, now is the time to earn it.

Dr. Ferrari's Closing Arguments

Dr. Michele Ferrari's final response to Robin Parisotto is HERE.

It's Not About the Dopes: Why the US Postal Case Matters

By Jim Ferstle
If you think the much publicized USADA prosecution of the doping conspiracy case against the US Postal cycling team is all about Lance Armstrong and the US Anti Doping Agency, you're wrong.  It is much more than that.  At it's core it is the attempt by USADA to tackle their greatest challenge, exposing and punishing what can generically be called "the sophisticated doper," athletes who not only use performance enhancing substances(PEDs), but also resort to extraordinary means to prevent people from exposing what they are doing.

For as long as I've written about this topic(since 1987) the frustration of those who operate the drug testing labs, and those charged with uncovering and prosecuting doping offenders has been that the vast majority of the people they caught breaking the rules were what you could call "low hanging fruit,"  the athletes who often accidentally ingested a contaminated supplement or "inadvertently" were caught with a banned substance in their urine.  These were not hard core cheaters who bought into the win at all costs mentality, but rather careless individuals who made mistakes.

But the current prosecution takes direct aim at the US Postal Six, the alleged ringleaders of "the most sophisticated, professionalized and successful doping program that the sport has ever seen," according to USADA.  The aim is to expose the lengths to which some will go to achieve success in sport.  As I've often told those who ask why I'm still interested in this topic after a quarter of a century I say that it encapsulates the best--athletes striving to be the best they can be in their chosen hobby/profession--with the depths to which they will go to achieve those goals.  It is a fascinating study of human nature.

It's a topic that involves psychology, physiology, pharmacology, ethics, morality, and a host of other fields.  In literary terms it is Shakespeare in spikes, a fascinating journey through shades of gray, as well as black and white.  The technological and social changes of the last 50 years has transformed society and this is reflected in our views on sports.  They have been transformed from the games we played for fitness and recreation or watched to be amazed by the exhibition of physical talent, to entertainment and recreation businesses that generate billions of dollars in revenue.

This has an impact not only in economic terms, but in social ones as well.  Sports "stars" become celebrities with influence rivaling, if not surpassing, those in other professions and an income to match that status.  College scholarships are almost the equivalent of a four-year salaried career and as much a sought after goal as a short term professional sports contract for those not gifted enough to make the "big leagues."  All this leads to a "trickle down" effect. The pressure to perform is not only on the small minority of the greatly athletically gifted, but also to the families of those who want their children to get a good college education, but can't afford it any other way.

A graphic example of the temptations of this reality hit home for me in 1988.  After Ben Johnson tested positive at the Seoul Olympics and the surrounding publicity delivered the unintended message that: "Hey, steroids work."  A mother took her son to an in law of mine who was a Twin Cities pediatrician.  The mother  said to her: "I want you to prescribe some stanozolol(the banned steroid Johnson took) for my son(a wrestler) because he needs to get better."  Or a similar story told to me recently by a high school coach at a private school in Illinois where the doctor of the one of the school's football players  told the parents that he should give some growth hormone to the teenager because "he needs to get bigger."

Doping is not just for Olympians or professional athletes anymore.  Masters cyclists are getting busted for using recombinant erythropoietin(EPO), the blood boosting drug that is one of the most potent performance enhancers used by athletes.  This reality of modern sport is only getting more advanced as another coach told me recently that research into genes, receptor cells, and the mysteries of how the body does what it does is unlocking a whole new territory/definition of doping.  Instead of injecting oneself with pharmaceuticals, the next generation of performance enhancers will be manipulating one's cellular functions and capabilities to do what PEDs do today without the potential negative side effects.

Why all this matters is that the "culture" of top level and elite level high school sport has changed.  People have always cheated, but it was usually a singular, individual indiscretion.  Now it's an industry.  It's not merely one off doping, it's a sophisticated system of manufacture, delivery, and consumption of products and services provided to give an athlete "the edge" on the competition.  To break that culture, the most potent battleground is on the level of the sophisticated cheaters.  They are the "role models,"  the engine driving the doping train.

When the BALCO case broke, many of the athletes who were caught were not the big name stars, but those striving to reach that status.  Many of them struggled with the decision to dope and, when caught, ultimately confessed to their "sins."  But when asked to go the "extra mile,"  to give up their suppliers, to tell the full story of the network that was set up to service this industry, they balked.  Marion Jones, who had not and ultimately was not convicted of a doping offense, was frequently cited by these individuals who said: "Why aren't you going after her?  Why haven't you busted her?"

To kill the beast, you have to cut off its head.  The head of the doping beast is the sophisticated doper and the enablers around him or her.  That is why the US Postal case matters.  To change the doping culture, you have to demonstrate that no matter who you are or when you did it, there is a price to pay.  A price commensurate with the crime.  For the US Postal Six this is not a "witch hunt" or an unfair targeting of individuals.  It is an attempt to change the culture. To return sport to the best athletes.  This case will not accomplish that in one fell swoop, but it is a step in the right direction.

For details of the USADA/US Postal case go HERE.

The Scientists Debate, Round Two, Ferrari Response to Parisotto Rebuttal

Dr. Michele Ferrari has responded to Robin Parisotto's rebuttal  HERE.

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.

The Scientists Debate--Rebuttal to Ferrari

By Robin Parisotto

Point 1

Michele Ferrari:  The value of Hemoglobin=13.0 was taken the last day of the Giro, dated  May 31, 2009, preceded by a Hemoglobin=13.6 dated 18/05/2009 and a Hemoglobin=14.8 at the start of the Italian race (May 7, 2009), a decrease of 12.2% (from 14.8 to 13.0) fully compatible with what is reported in the literature with regards to cyclists involved in stage races (Int J Sports Med 2009, 30:130-138): Hemoglobin decreases by an average of 11.5% from the beginning to the end of the event, with individual drops ranging between 7% and 20.5%. 

This reduction is mainly due to an increase in PLASMA VOLUME and it is therefore normal for reticulocytes not to have increased... 

Robin Parisotto: It is interesting that during the Giro there was a volume shift of 11.5% but not during the Tour, arguably a much more arduous race. In the Tour,  Lance Armstrong’s Hemoglobin actually increased from 142 to 145 during the course of the race. While this represents only a 2% increase, it is a long way from the 11.5 and up to 20% decrease in Hemoglobin, typical of long races as proclaimed by Ferrari. You cannot have it both ways. Others have also made the same conclusions.

NY Daily News story on blood analysis is HERE.  Cyclingnews article is HERE.

Point 2

MF: The values ​​of Hemoglobin=16.0 in the samples reported as numbers 14 and 15 were collected on two consecutive days (June 16, 2009 and June 17, 2009) at altitude. 

RP: From the Cyclingnews article (see below)  it is indicated that Armstrong  had spent time at altitude between the low Hemoglobin value and the high Hemoglobin values, but it is unknown to me if the tests (conducted by the UCI) were while he ‘was’ at altitude as Ferrari has claimed. If these tests were conducted after returning from altitude then they are comparable to the Hemoglobin value of 16.1 when Lance Armstrong was tested at altitude on August 12, 2009 (I did not have this data point in the data set initially evaluated).  It would be unusual for both of the tests in June to have been done while at altitude however. The Biological Passport is informed by data collected at different times, different places and different conditions in order to assess any influence that factors such as altitude exposure could have on the profile. This can only be done if you have other reference points such as tests performed at or near sea-level.

According to the Cycling News article, the blood samples show major fluctuations in his hematocrit ratio. For example, it said, his hematocrit on May 31 2009, was 38.2% but 45.7% only a few weeks later, on June 16.

Cycling News excerpt: It is expected that Armstrong will challenge this evidence “by summoning medical experts who may say that a person's hematocrit score could conceivably jump 7.5 percentage points in 16 days because of external influences like changes in altitude and heavy perspiration.” For example, he was in Aspen, Colorado, USA, at nearly 8000 feet above sea level between the two above-mentioned tests.

Point 3

MF: The Athletes Hematological Passport Interpretation Technical Document (2.09) recommends the adoption of correction factors in Hemoglobin values ​​for athletes who reside in or have stayed at altitude in the two weeks prior to collection. For altitudes between 2000 and 2500m the correction factor is 0.8: therefore Hemoglobin=16.0 becomes 15.2. This value is perfectly in line with the results of the ten samples taken out of competition from October 15, 08 to April 30, 2009, which show an average value of Hb=14.8. 

RP: If the values that were posted on the Lance Armstrong website were those of official tests  the correction factor of 0.8 would have been applied if the Doping Control Form indicated that Lance Armstrong  was at or had been at altitude. Therefore based on Ferrari’s view the actual Hemoglobin value was 16.8 and not 16.0. In any case, if the true (official) Hemoglobin value was 15.2 then surely Lance Armstrong would have posted that value rather than the higher value. I cannot think of a reason why an official anti-doping test would consist of ‘two’ results ie. one for the athlete and another for the Passport evaluation.

Point 4

MF: The same Hemoglobin Z-score for samples 14 and 15 is equal to 0.75, when altitude is correctly taken into account. I remind you that this parameter is indicative of suspicion of doping when it is >3.19 (a value that corresponds to a 99.9% probability). 

RP: This is unapplicable information as the Z-score is not utilized in the Biological Passport. The OFF-score, a formula based on Hemoglobin and reticulocytes values is used. Irrespective the passport does not just look at a single parameter and how abnormal it is or not but rather the pattern, the magnitude of changes of the four parameters involved and at what times they are occurring (in-competition, out-of-competition or pre-competition). This helps to form a picture by which an evaluation can be made.

Point 5

MF: The values ​​at altitude of Hemoglobin=16.0 in June 2009 are further confirmed by the sample taken on 12/08/2009, always collected in Aspen, with Hemoglobin=16.1; a value that Parisotto refrained from showing, but that can easily be found in the same source quoted by the Australian author (Cyclingnews.com, July 13, 2012), along with 37 other blood samples reported by USADA.

RP:  The data I referenced did not contain any of this information. As part of the Biological Passport process this information only becomes available after an initial evaluation is conducted and where there is suspicion that would require the availability of such information to help guide a final conclusion/recommendation.  My opinion was formed in the context of an initial evaluation.

The other point is that there is no explanation why the reticulocyte values associated with the two high Hemoglobin values (allegedly due to altitude exposure) have decreased when the Hemoglobin is increasing. Whether you are at altitude or not if you are making more Hemoglobin (therefore more red blood cells) then it is intuitive that you should have more young red blood cells (reticulocytes), not less. I mean that is the point of altitude exposure in the first place, ie. to accelerate and increase, NOT decelerate and decrease your red blood cell production.

A Scientific Debate

Earlier this week we posted an article by sports scientist Robin Parisotto of his analysis of biological data provided by the cyclist Lance Armstrong during his comeback for the 2009 Tour de France.  Because the subject of his analysis was Armstrong, the article generated a lot of interest, such is the nature of the news business these days that when a "celebrity" is involved readership figures go up.

It also generated a rebuttal from Dr. Michele Ferrari, an advisor and friend of Armstrong and a target of the USADA charges of being a part of a doping conspiracy involving Armstrong and his teammates.  Both Armstrong and Ferrari refused to contest the charges before sports arbitration panels.  Ferrari saying that he was never informed of the charges.  USADA responding that copies of the charges were presented to his lawyers and delivered to his home.  In response to Parisotto's conclusions, Ferrari wrote a detailed response on his website that you can find HERE.

This back and forth between sports scientists demonstrates the intricacies of the process of of attempting to prove guilt or innocence in a doping case.  It features the often uncomfortable relationship of the scientific and legal community.  Lawyers gravitate toward arguments, "proofs" that are convincing and short on ambiguity.  Scientists start with a theory and try and prove it right or wrong.  They deal in more probabilities than seeming certainty.

Why does all this matter?  While philosophers and ethics experts have a grand time debating the need  or efficacy of them, sports are defined by rules.  One of those rules is that athletes are not supposed to be able to impact the outcome of a sporting event by cheating, breaking the rules.  Using biological and/or pharmacological means to attempt to enhance one's performance is one of those rules.

So when an athlete, such as Armstrong, is charged with a doping offense sports scientists are often on different sides arguing if, in fact, a doping violation was committed.  As doping techniques have become increasingly sophisticated, the science for detected what is being done has become more complicated.  Thus we have debates like the one here where one scientist takes issue with another over what the data collected means.  The fate of the athlete depends on the outcome of that debate.

It's All About Blood

By Robin Parisotto

Robin Parisotto is a sports scientist based in Australia.  He was part of a group of Australian scientists who helped develop the first blood tests for detecting use of "blood doping" by athletes for the Sydney Olympics in 2000.  Currently his input is sought by sports federations on cases of suspected blood manipulation, biological passport abnormalities that, if confirmed, lead to the sanction of athletes for doping violations.  

The USADA(United States Anti-Doping Agency) case, where charges were brought against Lance Armstrong, his team manager, and team doctors and advisors has received a lot of attention.  Even more since Armstrong decided not to contest those charges before an arbitration panel, stating that he could not get a fair hearing in that forum.  The result being that USADA has levied sanctions commensurate with the violations listed in the charge letter.

UCI(cycling's governing body) are waiting for the details of the case file to be submitted to them before any action can be taken on the sanctions proposed by USADA, which include stripping Armstrong of his race results including his seven Tour de France victories from 1999-2005.

The following is an analysis Parisotto did recently using the blood  values cyclist Lance Armstrong posted on his website back in 2008-2009 during his comeback to competitive cycling for the 2009 Giro and Tour de France. This was not part of any official investigation into the data, but more as a matter of curiosity about available information on the case and what it can tell us.

Part of USADA’s charge letter that led to the sanctioning of Lance Armstrong(LA) and other "co-conspirators" was that there was strong evidence of blood manipulation(blood doping) in data examined by USADA. I can only presume that some/all of this data included information that Lance Armstrong had posted on a website some time ago where the UCI and USADA were referenced as the testing agencies. 

To better understand the basis for charges against Armstrong, it is worth remarking on some of this data.  The figures referenced in this article are from Armstrong's published blood values for 2008-2009.

The following graphic indicates a fairly regular and normal pattern of Hemoglobin (Hb) values until a significant drop on May 5, 2009, four days before the start of the Giro d'Italia(the Tour of Italy which was contested from May 9-31, 2009 and where Armstrong placed 12th). This is followed by a quite staggering increase on June 16, 2009 (further explained below), shortly before the Tour de France(which went from July 4, 2009 to July 25, 2009 and Armstrong placed third).

Fig.1 Hemoglobin values for LA October 2008 to July 2009

The graphic below is significant because while Hemoglobin appears to have been significantly disrupted, the reticulocytes (young red blood cells) have suddenly diminished and stabilized just before the Tour de France. This change is counter-intuitive (for reasons stated below).

Fig.1 Reticulocyte values for LA October 2008 to July 2009

The charts show a halving of the reticulocyte values in circumstances when the Hemoglobin has risen dramatically, which is not consistent with normal physiology. If one is making more red blood cells and increasing Hemoglobin then it is inconceivable to not have more immature red blood cells (reticulocytes) in the body of a normal healthy person.

The decrease in Hemoglobin  from April 30, 2009 to May 31, 2009 (149 – 130) in samples 10 to 13 is 15% however there is no expected increase in reticulocytes. In fact from October 16, 2008 the average reticulocyte levels are 1.1 but from May 18, 2009 the average reticulocyte levels are 0.6.

The sudden increase in Hb from sample May 31, 2009 to June 16, 2009 (130 – 160) in samples 13 to 15 is 23%, however the response in reticulocytes is again not consistent with normal physiology. Such a scenario is consistent with a deceleration in red blood cell production following auto-bleed and re-infusion(i.e. removal of blood to store for later re-infusion, otherwise know as blood doping). 

The subsequent low reticulocyte values are consistent with re-infusion of blood and continued micro-doses of rhuEPO(recombinant erythropoietin) to ‘stabilize’ and therefore mask the expected response in reticulocytes.

A Cycling News article of July 13, 2012 noted that if USADA were to present evidence such as this during a legal hearing of the charges, this evidence of doping would be challenged by Armstrong lawyers “by summoning medical experts who would say that a person's hematocrit score could conceivably jump 7.5 percentage points in 16 days because of external influences like changes in altitude and heavy perspiration.” Reportedly Armstrong was in Aspen, Colorado at nearly 8000 feet above sea level between the two above-mentioned tests. 

There any number of studies that refute the hypothesis that such a large increase in Hemoglobin is merely a response to altitude exposure.  To suggest that a 23% increase in Hemoglobin and a 50% decrease in reticulocytes was the result of time spent at altitude is stretching the bounds of the known and documented physiological responses to altitude exposure. For example, the Ashenden et al study in 2003 demonstrated that in no less than 7 study groups either at natural or simulated altitudes (above 2600 metres – about 8500 feet) that even after 4 weeks of exposure the increase in Hb was, at best, muted.

The largest increase in Hemoglobin was 9.5% in a group of elite cyclists returning from living and training in Toluca (Mexico) after 4 weeks. The Hemoglobin measures were taken 7 days after returning to sea level conditions. In all other study groups there was no increase or at best a 1-2% increase in Hemoglobin. Similar responses were noted with reticulocyte levels. Whatever way you cut it, Armstrong's blood values are undoubtedly indicative of blood manipulation. 

This is hard empirical evidence lending support to the charges filed by USADA.  If this profile had been submitted to me for review by me as a member of the Passport Panel(biological passports which are used by the UCI, cycling's governing body, and the IAAF),  it would have been assessed as an anti-doping rule violation particularly in view of the timing of the disturbances leading into the 2009 Tour.