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Saturday, January 24, 2009

Random ramblings on cycling

Doping control 2009 and beyond

Well, it's been a week since the last posting, and a week since a promise to tackle the mind over matter issue in more detail. Unfortunately, my own mind was out of it this past week, and I'm citing writer's block and lack of inspiration as reasons for the week-long silence!

And since that furnace has not yet ignited, I thought I'd do a very brief post inspired by some unrelated events over the last few days. They all concern cycling, in some form.

The primary stimulus for my thinking on doping is NOT Lance Armstrong's return to riding in Australia (though that certainly doesn't distract me from it), but rather the privilege I had last week of spending some time with the journalist David Walsh.

Walsh, for those who don't know, is the Chief Sports Writer with the Sunday Times, and one of the foremost journalists covering the Tour de France. He has written two books: LA Confidential: The Secrets of Lance Armstrong (in French only, with Pierre Ballester, and From Lance to Landis: Inside the American Doping Controversy at the Tour de France.

Both books have, predictably, been highly controversial, with various lawsuits and threats to prevent publication (the reason the first one was published in French only). I don't read French, but we did a review on the second book way back in 2007, and meeting with Walsh inspired a second reading of that book, which led to these musings on doping (and much more thinking and work, but that will be covered in the future).

A view on doping

First off, an interesting article on the state of doping control was published about a month ago in the International Sports Medicine Journal. It was authored by three Danish researchers, all of whom are quite influential on the world anti-doping stage. For example, the third of the three, Rasmus Damsgard, is currently the anti-doping Project Manager for Astana, for which one Lance Armstrong has recently made a comeback during the Tour of Australia.

You can read the article here - it's the Editor's selection, which I gather means that anyone can view the full article. If you battle, just drop us your email address in the comments section and I'll gladly send it to you.

To summarize, the article makes for a quite a nice introduction to doping control, because the author's cover the basics of doping control, including why out-of-competition testing is so important, how athletes are monitored throughout the year, how samples should be handled and tested, and the value of integrating the testing programmes of all the various bodies now doing the anti-doping bit (and there are plenty).

A couple of things jump out at me:

Anti-doping within teams

First, it's interesting that on the second page of the article (pg 156 of the journal), the authors discuss the "biological passport system", where riders' blood and urine values are tracked over the course of many months to develop an individual profile for each rider. The paper states that "Specific results showing the variation in the numbers of tests per rider and the timing of these tests have not yet been published, but it is anticipated to do this in the very near future".

I can't help feeling that this is the most crucial piece of this puzzle and the one that should have been in place from the very beginning. Towards the end of last year, I actually wrote a piece where I said that doping control should be made "open-source" (like Linux or Wikipedia) so that it is fully transparent. If this does not happen, then these team-led anti-doping programmes could become a farce, because the team still controls the flow of information.

In fact, I'd go so far as to say that unless the process is laid bare and made 100% transparent, the team anti-doping programmes are actually in danger of being destructive, because what teams are doing is "employing" experts like Prof Damsgard to manage their anti-doping programmes, but then controlling the flow of information generated as a result. This aspect of anti-doping control, then, becomes ornamental, a facade behind which teams can shelter and find some favour with authorities.

So the question is this: What happens if Prof Damsgard or any other scientist employed within a team structure discovers that athletes are doping? Does he report this to management, to WADA, to a national anti-doping programme, or does he remain silent? Because if the answer is the latter, then the teams have effectively neutralised doping control from within by removing power from experts, having such experts is actually a step back for the sport, not forward.

I'd be curious to know the answer to that question...

Example of the biological passport

Secondly, there's an interesting table in the paper showing the blood and urine values of a rider over a 7-month period in 2008. I've copied that table below (click to enlarge), and highlighted the interesting values.

The rider is implicated as having "suspicious values" in July 2008, because the reticulocyte (immature red blood cells) count is abnormally low, and also much lower than values measured only one month before. A reduced reticulocyte level suggests that the athlete has previously used EPO

Also, the BAP % (far right column), which is a measure taken from a urine test, is also suggestive of EPO use - anything above 80% is an adverse analytical finding.Note also the relatively large increases in hemoglobin and hematocrit that occurred in June. These are not by themselves a problem, but they do contribute more to the evidence that this athlete has used EPO during May or June.

So now, the same question is asked: This is a great example of how the passports should work, and what they look like. But, if this was a result collected by team's internal doping control programmes, what is the next step of action taken? Was this athlete investigated further? Do the anti-doping 'personnel' have the mandate to pursue, or do they simply observe?

To me, there is still too much secrecy. Having written that, I then think that perhaps I'm ignorant of the internal process because I'm an outsider. Perhaps the people involved in the teams know all the answers. Then I realised that this is precisely the point - who needs to be convinced that cycling is cleaning up its act? The outsiders, who include not only spectators, but sponsors, other cyclists, and the media.

And while doping control may be growing, and cyclists are now faced with the most intensive testing regimes of any sport. But all that comes to nought if the general trust in the sport cannot be won back, and for that, such secrecy cannot be sustained.

On the whole, anti-doping almost has a similar feel to the "medical programmes" that were instituted by the teams in the mid-1990's. At the time, doping was widespread (as it still is, sadly), but often not through team-run programmes. However, it became very clear that riders would dope, whether or not the team provided the "programme". As a result, many teams began to formalize doping programmes (which were called medical programmes) not to dope better, but to do so more safely. It was a case of acknowledging that it was going to happen, and at least a responsible team could control it better, winning more races and doing so more effectively (that is, without getting caught or killing the cyclist).

The internalization of doping control threatens the same, though it would have a different outcome - it could, in theory, facilitate even greater control of the flow of information. It has the potential to create so many conflicts of interest and potential clashes between different bodies that unless managed, the web of secrecy will get even heavier, and the code of silence (omerta) will simply be translated into a higher, more sophisticated language.



Anonymous said...

DW also ghosted Paula Radcliffe's autobiography (which includes the amusing anecdote about her reading an article in - I think - l'Equipe insinuating she doped, and ringing up the journalist and giving him a very hard time about it... the journalist may have forgotten she has a first class degree in French and German!)

Anonymous said...

The results from fortnightly or monthly urine and blood test results are interesting, but totally non scientific, for two reasons:
1. Are we sure we have the data of a completely normal population - I bet there is variation but as much as 2% just from lab standard deviations, normal person fluctuations and a host of influences known and unknown.
2. If the variation is truly out of possible normal error of measurement, then there still needs to be more information on athletes life style - For example, was there some altitude training going on in May and June perhaps, what about some dietary manipulation of iron, what about illness in May - perhaps June's higher result is normal but May's was abnormally low due to an infection. What about hydrations status at time of test - there should be a creatinine done at the same time, and then what about those unknown influences yet to be taken into account.
3. What I would like to see in a post such as this is the yearly graphs of exactly the same measures from a normal population - heck have you even checked your own tests at such a high frequency to know the true variability of the tests.
The next time I read about doping, where the proof is as circumspect as this I would like proof that the values are out of keeping of normal fluctuation of a normal relevant sample population.

Ross Tucker and Jonathan Dugas said...

Hi Anonymous (1 and 2)

I spoke to David about Paula as well - interesting stuff, though he didn't comment on that particular story!

Then to the second anonymous poster:

You raise some interesting points, but I can't help feeling you've missed the whole point here. First of all, you need to read that article by Damsgard and colleagues, because they actually bring up and discuss the very points you raise, which are valid.

However, the issue about a "normal population" is precisely the point - the cycling population is not normal and that's why this kind of longitudinal testing is required to establish an individual pattern, rather than a comparison with everyone else. The article makes this very clear.

Then secondly, the error of measurement point you raise is important, and they do address this in the paper with their suggestions re blood sampling, analysis and the tester variability. This is an acknowledged problem.

So too is lifestyle, which you're correct to bring up. Again, the article discusses this, and I believe that it's easily controlled for. You must remember that the "normal" variation in these measurements is not that difficult to pin down, and so a change in hematocrit of 5 percentage points (or about 10%) is a big one, indicative of further testing. Remember also that these tests are the guide to further testing, not the be all and end all, which certainly influences their value.

Once again, the article makes all of this abundantly clear, which is why I referred people to it rather than paraphrasing the entire thing.

And then finally, I'd love to be able to post a year's worth of data of some cyclists, but I CAN'T, because it's not available! I even raised that point in my post - it's the whole problem! So yeah, it would be wonderful to do that, and if you could give me the data, I'll do it! But this was not a post about that, it was my comment on the doping control measures.

THen you say "have you checked your own tests". Which tests exactly are those? The table is drawn from doping control, not mine. Did you even read the post?


Anonymous said...

Out of competition testing is so important as you've noted. However, to the public's knowledge, Catlin never tested Armstrong OOC. Should Catlin have no baseline on him OOC, does it render the rest of the testin done on him in competition as invalid?

Ross Tucker and Jonathan Dugas said...

Hi Anonymous

I think so, yes. I saw a news article yesterday actually talking about Catlin and his role in certifying that Armstrong is clean. I think it's a front, completely, designed to create the illusion of Armstrong being transparent.

The problem when you pay "independent" scientists to verify your status is that you control them and everything they get to see. This is precisely the problem with what all the teams are doing, and again forces me to ask the question of what happens if an "independent" expert spots signs of doping? The answer is nothing, they'll be silenced as part of the team and the show will continue as it did before. This concept of teams appointing experts is a flawed system.