Monday, 15 October 2012

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.




12 comments:

  1. Hello

    The science might also say no. Altitude tents are legal in France but not in Italy. Blood samples taken in France and a baseline taken in Italy for comparison may only be showing the results of a legal method of maintaining a high level of red blood calls. If so then the baseline taken in Italy would show the cyclist was obeying local cycling rules and not engaged in illegal blood doping.

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  2. An interesting point anonymous. But it is not the baseline value that is the problem. This could indeed vary as you suggest. However, it is the trend WITHIN the Tours that causes the concern. In France a plasma volume increase changes to a decrease DURING THE TOUR. Hypoxic tents work much slower than this. I'm with Chris Gore on this one. A transfusion is the most likely explanation by far.

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  3. Hello Professor

    The reference that Gore makes of 'one in a million' , is he implying that there is actually a portion of the population who could produce such results naturally (though extremely rare) or is this just a reference to ,say, scientific impossibility . In other word is this an actual statistic that adds to the report or just a metaphore.

    Thank you for your previous comment.

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  4. I am sure Gore means this as a calculation. I'll need to take a closer look at this to try and figure out the details, although it might not be possible without seeing the actual data. Hopefully I will be able to get back to you later. Chris

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  5. I think if Armstrong fought the case, this data would have come out in court and we would have had more details. I think I am lost at even attempting this calculation without the data. But I trust Gore to have done it properly.

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  6. An increased reticulocyte percentage may indicate conditions such as:

    Bleeding: If you bleed (hemorrhage), then the number of reticulocytes will rise a few days later in an attempt to compensate for the red cell loss. If you have chronic blood loss, then the number of reticulocytes will stay at an increased level as the marrow tries to keep up with the demand for new RBCs.
    Hemolytic anemia
    Hemolytic disease of the newborn
    If your marrow is unable to keep up or is not functioning normally, then the number of reticulocytes may be normal or only slightly elevated despite demand but will eventually decrease due to lack of adequate production. If the number of reticulocytes is not elevated when you are anemic, then it is likely that there is some degree of bone marrow dysfunction or failure and/or a deficiency of erythropoietin.

    Decreased reticulocyte percentages may be seen, for example, with:

    Iron deficiency anemia
    Pernicious anemia or folic acid deficiency
    Aplastic anemia
    Radiation therapy
    Bone marrow failure caused by infection or cancer
    The reticulocyte count gives an indication of what may be happening but is not directly diagnostic of any one particular disease. It is a sign that further investigation may be necessary and a tool that can be used to monitor the effectiveness of therapy.

    If reticulocyte numbers rise following chemotherapy, a bone marrow transplant, or treatment of an iron or vitamin B12 or folate deficiency, then bone marrow RBC production is beginning to recover. In conditions causing RBC overproduction, the number of reticulocytes and RBCs, the concentration of hemoglobin, and percentage of hematocrit will all be increased.

    Is there anything else I should know?
    Patients who move to higher altitudes may have increased reticulocyte counts as their body adapts to the lower oxygen content of their new location. Smokers also may demonstrate an increased number of RBCs and reticulocytes.

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  7. I am not certain that there is any 'science' just yet, only data analysis (data stacking ?).

    The 1999 EPO testing does not meet scientific rigors or criteria.

    The 2009 Giro seems to show a clean cyclist in thatTour and the use of a legal hytoxin tent through out the 2009 Tour De France could account for the data observed in the cyclist's blood samples.

    The word 'attributed' in the Tour De Suisse has no place in science.

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  8. Hello

    While hypoxic tents work slowly they do work ( and are legal in France). High altitude conditions have been shown to increase hemoglobin by 9.5% in Toluca Mexico in one group from the Ashenden study of 2003. Further if a cyclist had chemotherapy that stressed the bone marrow, a low heart rate ( 40 beats per minute resting, or lower) and controlled breathing (learned from cancer therapy) would all these combine to create that "one in a million" cited in the USADA report ?

    The above would seem to be a testable idea in the cyclist medical defense or perhaps could be validated by data from the cyclist medical and training records.

    The above may also be at best a prayer to St. Jude ( patron of hopeless causes) or put in the 'negligible probability' file but it does seem testable.

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  9. Hello

    The Giro baseline establishes what to look for when the cyclist has a ride free of doping, that is clear. There seems to be several 'X' factors in the Tour De France to take into account of the cyclist being examined.

    The allowance of hypoxic devices during the tour (legal blood manipulation) medical conditions of stressed bone marrow due to chemotherapy treatment.

    It is also observed the blood panel measured occurred as the cyclist was in high altitude stages of the race.

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  10. Hello Professor Cooper

    The following link takes you to what maybe an interesting debate on the Armstrong doping case with two different points of analysis emerging between two posters called Doctor Falsetti and 88rex.

    It might be a bit much to ask but given your interest in sports medicine I was wondering if you could give an opinion on the quality of the points made throughout the thread.

    Thank you in advance for your response.


    http://forums.roadbikereview.com/doping-forum/armstrongs-questionable-blood-values-285093.html

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  11. I think I will wait to comment till after the Oprah interview...

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  12. Hello Professor Cooper

    Is this data and chart of any value in assessing the performance of drug a free cyclist:

    http://www.guardian.co.uk/politics/reality-check/2013/jun/28/impossible-to-win-tour-de-france-without-doping-armstrong

    Thank you for your response in advance.

    Sincerely

    Anonymous

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