Did the Wall Street Journal get it wrong about blood doping?

A bit of a dramatic title, but I feel the need to cleanse myself and change topic after talking about Lance Armstrong to the media all day yet again (following UCI confirming the stripping of his Tour titles). So instead I would like to visit a review of my book in the Wall Street Times by Will Carroll (http://online.wsj.com/article/SB10000872396390444464304577537371308904132.html). Let me say at the start that this is the most critical review of my book, but I love it all the same. Most of my other reviews pretty much recap the book in an opinion-free way. It is nice that they like it (of course I am an author I love praise!), but I didn’t feel I heard the reviewer’s voice and opinions. But the Wall Street Journal review reads a lot more like the George Orwell’s book reviews. At the end of it you have leant a lot about Orwell’s opinions, had a great read, but might have forgotten that a book was actually being reviewed. Great stuff.

Still, boring biochemist that I am, I do have to make one point about the science in the review that is inaccurate. In the book I talk about Eero Mantyranta, the Finnish cross-country skier who had a genetic anomaly that “naturally” enhanced the number of his red blood cells. Carroll says that “Under current testing protocols, genetic anomalies such as Mr. Mantyranta would be singled out the way that Lance Armstrong has been”. This is not the case. As the USADA report on Armstrong shows, Armstrong had a low number of young red blood cells in a series of 2009 and 2009 blood tests. On its own this is not evidence of doping. But suspicion is aroused when you compare the samples taken during the Tour to those taken before when there were a lot more young red cells. This comparison to a person’s own blood samples is at the heart of the athlete biological passport; here it suggested a period of time when, according to Prof. Chris Gore in the report, Armstrong must have had a blood transfusion.

What then about Eero Mantyranta? He would have a constant number of red blood cells; high but not varying. So he would not have been “singled out” by the biological passport. Of course there is a separate decision as to whether it is “fair” to have someone with such a genetic advantage compete (and he would have had problems with the 50% hematocrit limit in some competitions). But he would not have been suspected of doping if his blood was analysed carefully under today’s system.  

Did Lance Armstrong dope? The science says Yes

I said of the original USADA statement in my blog of August 24:

“I personally would like to know what was the basis for the USDA statement ‘Additionally, scientific data showed Mr. Armstrong’s use of blood manipulation including EPO or blood transfusions during Mr. Armstrong’s comeback to cycling in the 2009 Tour de France’ ”.

True to my request the scientific evidence against Armstrong is clearly presented, though somewhat buried in the report (only 6 of the 164 pages go into the tests). The controversy of the 1999 Tour de France EPO test is discussed of course. It pains an Englishman to admit that a Frenchman and Australian were right, but I think this is pretty unequivocal now. The French journalist, L'Equipe's Damien Ressio, correctly identified six positive samples as Armstrong’s [1] and the Australian blood doping expert, Michael Ashenden, got the details of the story spot on in this interview [2].

Interestingly Armstrong’s samples accounted for 46% of all the EPO positive samples found. It does look like he was taking EPO throughout whilst others hoped their pre-tour red blood cell increase would be enough to last the Tour.

The second piece of evidence – and this is new – is the blood samples taken from Armstrong during his comeback. Again an Australian – in this case Chris Gore – analysed the data in detail. Endurance cycling, day after day, increases your plasma volume and decreases your red blood cell concentration. This happened to Lance Armstrong through the 2009 Giro. However, in the subsequent Tour de France, the situation was different. His plasma volume rose, as expected, on days 1-7 of the Tour, But rather miraculously this volume decreased over the next three days and the red cell count increased. The only sensible conclusion is that he had a blood transfusion on or around day 7.

Gore also concluded that in many of Armstrong’s blood samples there was a dramatic reduction in the number of young red blood cells. These young cells, called reticulocytes, are formed when you are in the process of making new mature red cells. If you transfuse blood to supermaximal levels, your body tells you to stop making new cells. Therefore there is a large decrease in the number of reticulocytes. Armstrong showed exactly this effect on a number of occasions. This is the relevant quote from the report "Prof. Gore concluded that the approximate likelihood of Armstrong’s seven suppressed reticulocyte values during the 2009 and 2010 Tours de France occurring naturally was less than one in a million”.

The final piece in the analytical jigsaw comes from the 2001 Tour de Suisse. Here there are a number of suspicious EPO samples attributed to Armstrong. UCI have not released this data for further discussion. So this part of the story remains unfinished business between USADA and UCI.

In short, I don’t thing Armstrong’s supporter’s can realistically claim that he has not failed a doping test. He may not have been officially sanctioned due to a test, but the circumstantial evidence is far more damning than several people I note in my book who have lost medals due to positive tests through no fault of their own e.g. the Rumanian gymnast, Andreea Răducan.

[1] http://autobus.cyclingnews.com/photos.php?id=photos/2005/interviews/damien_ressiot/cycling-usa-armstrong-fr-41

[2] http://velocitynation.com/content/interviews/2009/michael-ashenden

Lance Armstrong - was he just better at doping?

OK, I need to rename my book Run, Swim, Throw, CYCLE Cheat. For those of us in the field have a lot of homework to do - 1,000 pages of documentation from USADA that illustrates the widespread nature of Lance Armstrong’s doping [1]. So as I said in a previous blog, beyond the sheer volume of incriminating evidence, what is new, at least to a scientist?  I can’t claim to have read more than a few extracts yet (I have a life and my own teaching and research to do after all). But what I have read seems to support one of contentions from an earlier blog - Armstrong was better as he was doping more smartly and/or taking more risks. Certainly in 1999 when he won his first Tour he was using EPO throughout the event, whereas others probably stopped once the race began. Given that there was no validated EPO test in 1999 this is perhaps a little surprising – although it agrees with Michael Ashenden’s interpretation of the later analysis of Tour samples [2].

The alternative view is that Armstrong always had the capability of being the top cyclist, but he was held back by a lower ability to deliver oxygen than his rivals. Once he could equalize this by taking EPO and blood doping, he was able to outperform them in the mountains and win consistently. In this model all Armstrong’s US postal had to do was dope as well as the other teams. How to choose between these two theories? Was Armstrong the best doper or the best cyclist once everyone was doping? What we scientists really need is a side-by-side comparison of all the team’s doping strategies from 1999-2006. That’s not too much to ask surely…….

[1]        http://cyclinginvestigation.usada.org

[2]        http://velocitynation.com/content/interviews/2009/michael-ashenden