Blood Doping and Blood Passports

I briefly discussed this article in a previous blog, but I thought it would be worth sharing it in more detail as it is freely available to read online. Also it was published after my book went to print so it is not discussed there. It is written for a scientific audience but I think it is not too difficult to follow for the intelligent layperson.

You can access it at:  http://onlinelibrary.wiley.com/doi/10.1111/j.1476-5381.2011.01822.x/full

The author is Carsten Lundby from the University of Zurich. It is a rather depressing summary of our state of play in detecting blood doping. Testing is especially tricky when the doping uses autologous blood i.e. an athlete pre-stores their own blood for a later transfusion. To counter this some sports, notably professional cycling, require athletes to have “blood passports”. The passport includes data from regular blood samples that have been taken to look for anomalous findings. These can include increases in red blood cell content (indicating a recent infusion of blood to aid performance) or increases in immature red blood cells (a likely consequence of a recent removal of blood to be stored for later use). A likelihood of doping score is calculated. But, as Lubdby stresses, this is not foolproof.

A recent study by Torben Pottgiesser at the University Hospital in Freiburg looked at control subjects who underwent a season’s blood doping program as if they were elite cyclists. Setting the probability level to 99% only caught eight out of eleven “cheats”. Setting the level to 99.9% only caught five. The danger of false positives is the problem here i.e. a positive test being triggered for someone who is not doping. Even setting the limit at a supposed 99.9% level, one test participant was initially “caught” who did not receive transfusions. On closer inspection the anomaly that lead to this false positive could be rationalised. But the lesson is clear. This data needs to be interpreted very carefully. This does not just require people trained in haematology, but also people who know the kind of tricks athletes use to avoid doping. It is therefore not surprising that, as outlined in my book, decisions to convict an athlete on an anomalous blood passport alone are likely to be appealed and ultimately decided in court.

For the curious, Figure 3 in the Lundby paper is one of the rare published examples of a doper’s diary; in this case a professional cyclist who was targetting success in a seven day race in March (Paris-Nice), a one day spring classic in late April, the three week Tour de France in July and the one day world championship race held in October. This makes salutary reading though we should not be surprised. Professional athletes take a scientific approach to all their preparations and drugs are surely no different.

Cheating in Sport

Literary festivals seem to attract good weather!  Lovely sunny day at  Christ Church Cathedral in Oxford for a discussion on cheating in sport. A great panel too: Daniel Friebe who, amongst other things helped Mark Cavendish with his autobiography; Richard Moore who is about to publish a book on he Ben Johnson/Carl Lewis rivalry that culminated at the Seoul 1988 Olympic 100m final; and Dave Farrar who has written on gambling in sport and commentates for football on ESPN. I even had a book with me this time (see my Words on the Water blog) and sold my first copy!

As for the discussion it was lively as ever. A lot centred on cycling given the panel’s knowledge in this area and the fact that – as usual – there were a lot of clued in cycling enthusiasts in the audience. The consensus seemed to be, whilst the sport is definitely not completely clean yet, it has got better. Part of this is that elite cyclists at least feel there is a chance they could get caught and punished. I don’t think the culture change is quite there, where self-regulation limits doping, but it is maybe on its way very slowly. The Alberto Contador story led to a lively discussion both during the debate and after, only some of which I can share on this blog. One person felt very strongly that it was unfair that only one lab. in the world could have made the positive clenbuterol test at the very low levels detected, so there was a lack of fairness involved in the process. I have some sympathy with this view. The counter argument is that a doping offence is a doping offence so he couldn’t complain at being caught. This led to a discussion on whether individual athletes should be targeted for more aggressive testing. It is really a case of whether you feel WADA and other anti doping agencies should act as passive referees merely adjudicating decisions or whether there should be an element of a more aggressive, almost investigative process, involved. The athlete biological passports really straddle these two areas. What is clear is that many of the high profile athletes charged with doping offences in recent years have been caught by law enforcement agencies or the courts, rather than the testing laboratories.  

One interesting point. Why is cheating more common in some sports than others? What is so different about “sports” like golf or snooker when competitors self report an offence such as moving a twig in your backswing in golf or brushing a ball with your hand in snooker? Perhaps there is another book in all this?

Designer athletes: fair play or foul?

A really interesting debate at the Cambridge Science Festival chaired my Linda Geddes from the New Scientist magazine. I was talking about drug doping and Steve Haake from Sheffield Hallam University about technological doping. The straight man was Steve Ingham, Chief Physiologist at the English Institute of Sport who talked about the normal training they had developed for the UK Olympics team. Nothing normal about this of course – they are pushed to the limit.  I actually felt a bit sorry for Steve Ingham; he has to be sensible as he represents the country, whereas the two academics can be more eccentric. I think Steve Haake wanted Formula One in the Olympics, but I said we would always want to watch people run using their own resources. Queue the inevitable discussion about the paralympic “Blade Runner”, Oscar Pistorius. Still I managed to add my own piece about Thierry Henry’s handball ‘cheating’ having been largely forgotten by the world whilst drug ‘cheats’ remain vilified for ever; I’m not even Irish and I quite like Arsenal, but I think there is at least a debate about double standards to be had here.  

Unfortunately I had to leave before the end (engineering works on the line on a weekday!) so missed the final vote. Still from the audience questions it seems that lifetime bans for doping are not favoured.

As usual there were some great questions from the audience. My favourite was the one about the man who had read about someone who had gone to the far East and learnt how to rapidly lose weight safely from a mystical guru. Consequently he could cheat the wresting weigh-ins and then gain his weight back before the fight. He then stomped on all the lightweight weaklings in front of him. I am not sure if this is true, but a mental image of the old TV series ‘Kung Fu’ flashed before me. Question: “Grasshopper – how can I win an Olympic Gold medal”. Answer: ‘Be at one with your spirit young Caine – and take lots of diuretics”

The Biomedical Basis of Elite Performance

"Photo by DAVID ILIFF. License: CC-BY-SA 3.0"

I’ve just come back from a great Physiology Society meeting at the Queen Elizabeth II conference centre (by the way a great conference venue right opposite Big Ben). There was a really interesting session on “Drugs in Sport”.  Speakers included: David Cowan from King’s College London who is heading up the London 2012 drug testing program; Carsten Lundby from the University of Zurich on ‘Blood Doping’; Martial Saugy from the Swiss Laboratory for Doping Analysis on ‘The Athlete Biological Passport’ and Fawzi Kadi from Prebro University Sweden on ‘Testosterone in Sport’. I learnt a lot - though thankfully not anything that contradicted my book. I suppose the most dramatic was the blood doping diary that Carsten showed – it seems that rest days of the Tour de France are just perfect for taking time off to dope. He also showed some data about a HIF inhibitor that you can take as a pill and acts as well as EPO in increasing the red blood cell number. The idea is in my book, but I wasn’t aware how close it was to being ready for action. I am assuming it is being tested for in anti doping laboratories worldwide, but of course no one would tell me.

The most telling contribution was Carsten’s view - in public and private - that autologous blood doping (doping with your own blood) is still essentially undetectable. Martial was less negative and suggested that the biological passport could identify dopers. Yet, as Carsten suggested, why risk a fancy new drug when the old fashioned tricks work just as well? It seems to me that at present testing needs to be linked to techniques more akin to police work. A couple of undercover cops or double agents should do the trick …..

Words by the Water

Just had a great time at my first literary festival: Words on the Water at the Theatre on the Lake at Keswick.  I was really well looked after by the organisers. I think I have found my retirement plan: wonder around the country to beautiful venues, hear interesting people speak and then buy their books. The highlights included chatting to Stephen Moss the naturalist, hearing from Mihir Bose about who he thought would light the Olympic Flame and learning from David Bainbridge that middle age was the best time of your life (actually he said most productive, but I misheard deliberately). But best of all was having a wonderful dinner sitting next to Jenifer Glyn at the Lyzzick Hall Hotel. Her talk was about the DNA crystallographer Rosalind Franklin. The perspective was different to more academic speakers I have heard as Rosalind was her older sister. It was a fascinating insight into the mind and dreams of someone whose life ended so young. Rosalind Franklin was of an era that meant she would never have considered herself a “female” scientist; just a scientist. Jim Watson of course inadvertently created the “Rosalind Franklin” industry by the cruel way he portrayed her in his book ‘The Double Helix’. Still there is no doubt that Franklin was a talented scientist who, even if she had been given any, would not have rested on her laurels post the Watson/Crick/Wilkins DNA days. Indeed her subsequent Tobacco Mosaic Virus work was really important.

But what about Drugs in Sport? My talk seemed to go OK, though I felt a bit ‘naked’ going to a book festival and book signing with no book (the OUP lawyers are still mulling over some sections). Still I had great questions. I have learnt not to underestimate either the intelligence or knowledge of these rather eclectic audiences. I was happily talking about hormones until half way through my answer I realised that my questioner knew more than I did. Not surprising as it turns out he was a retired professor of endocrinology! Undaunted I then proceeded to discuss some of the legal ramifications of the current court case about the UK’s lifetime ban on “drug cheats” competing in the Olympics. It turns out this questioner was a lawyer who had been involved in handling many of the most famous drugs cases. Ho hum. Suitably chastened I ducked the Lance Armstrong question, at least until afterwards in the bar.

Anyway my view, for what it is worth, is that WADA and the Court of Arbitration in Sport will win over the British Olympic Association and Dwain Chambers and David Miller will be free to sprint and cycle for us in London 2012. My new lawyer chum thought otherwise, but what does he know? My personal view is that it is important that the BOA case fails. Not because I want us to have a chance to do better at the Games, but merely that if one country can have stricter anti-doping rules compared to WADA it seems equally likely that another country will be able to have more lenient rules. Whatever you think about the pros and cons of drug testing and drug bans, sport is about trying – as best as we can – to have a level playing field.

More later after the BOA court case is decided (and also about Albert Contador when I can be sure that the case against the multi Tour de France winner is finally over for good).