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

Doping, drugs and cheating at the Paralympic Games

I finally have some time to blog after some happy times spent at the Paralympics; the highlights of what I saw being Sarah Storey at the velodrome, Hannah Cockroft and Shelley Long in the Olympic Stadium and, of course, Shiyun Pan the swimmer in possession of the amazing one armed butterfly stroke which made me forget that it was a Brit he was beating on the way to his world record.

So what are the similarities and differences in doping between the Olympics and Paralympics? Much is the same. Power and strength are key requirements for many Paralympians. So not surprising there were bans for users of steroids and human growth hormone [1]. Just as in the Olympics there were variations in the length of sentences. An athlete claiming that the green tea he took contained an unlabeled banned diuretic received a nine-month ban and missed the Games [2]. Yet someone who inadvertently took a banned substance in a nasal decongestant had a more limited three month ban; this finished a few days before the games [3] and she ended up winning a silver medal, coincidentally creating one of the moments of the games as the two British athletes fighting for the bronze medal in that event tried - and failed - to cross the line together to share the remaining medal [4].

So much, so similar. However, the two unfounded allegations of cheating that created media storms illustrated some of the differences between the two Games. Whilst the voices raised against the Olympic Chinese swimmer Ye Shiwen focussed on biochemical enhancements, those against the Paralympic 200m runner Alan Oliveira related to his equipment. Allegations of “technological doping” seem more prevalent in the Paralympics where naturally equipment is a bigger issue for more athletes. The French though remained equal opportunity accusers of the “unfair” advantages conferred on Team GB and Paralympics GB by their bikes and wheelchairs of [5].

More seriously are concerns about classifications. In the Olympics suh arguments are rare; after all the only classes are those based on gender and weight. Weight is readily quantifiable and, fortunately, accusations of males competing as females are rare. However, in the Paralympics allegations of athletes trying to cheat the classifications are more widespread [6]. Concerns about the fact that other athletes have unfair advantages seem to have triggered a more laissez faire attitude to cheating. Take the practice of “boosting”. Some Paralympians with spinal injuries lack the ability to raise their blood pressure when they start to exercise. This can limit performance. Therefore this pressure is “boosted” by extreme action; for example breaking a toe or blocking a catheter [7]. Boosting is dangerous and consequently banned. However, in an anonymous questionnaire study up to 17% of disables male athletes admitted to trying this [8]. This value is much higher than would ever be the case for an equivalent study on drug use. It seem likely that disabled athletes, in part, feel that boosting is justified if they perceive that others in their classification have a blood pressure response they lack. Rather like Ben Johnson’s excuse that everyone was doping so it made no difference if he did.  

As many have noted with regards to Pistorius’s outburst, this level of conflict can all seen as a positive sign that the Paralympics have come of age as an elite sport. However, there is still one area that I think progress needs to be made. As long as the equipment needed to compete is expensive, many countries will be excluded from competing meaningfully; this includes many of the 25,000 people per year who become amputees as a result of land mines. Still perhaps it is a bit churlish to ask the Paralympics to being about world peace and economic regeneration as well as changing our attitudes to people with disabilities …..

Talking about sports doping and Lance Armstrong at the Edinburgh International Book Festival

(the picture on the right is of Alex Hynes playing in a beautiful church on the Royal Mile) 

Last Monday I had the honour of talking about “Run, Swim, Throw, Cheat” at the Edinburgh International Book Festival. Although I have travelled to Edinburgh frequently to the Science Festival in spring or to various scientific conferences, this is the first time I have been in the festival in the summer since 1982 when I acted in a Hampton School production of Strindberg’s “The Father”. I portrayed a soldier and had 23 lines in total. The Scotsman newspaper was not impressed – it rated us 2/10. Undaunted the following year we renamed our company Hampton 20% Theatre! Anyway given this less than auspicious history, it was perhaps as well that I returned to the festival talk about science rather than act. After the talk I explored the fringe with my 17-year-old thespian daughter. We say five shows in eight hours; the rigour of fringing seemed to be the same as 30 years ago, though if anything the quality of the productions was better.

The talk seemed to go well  - I even managed not to mess up my red wine blood doping demonstration for once. As ever there were a lot of interesting questions. Again Lance Armstrong came up a few times. On my return the Essex Uni. Human Performance Unit Director Dave Parry reminded me of an interview with Michael Ashenden where the controversial 1999 EPO positive tests are discussed in a lot of detail. If you have the time it makes fascinating reading; at one stage it informs on a previous blog of mine that suggested that Armstrong might be better at doping than his rivals (maybe as he was less scared about being caught?).

Anyway the article in full can be found here:

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

Lance Armstrong and doping – what, if anything, is left to say?

http://lancearmstrong.com/news-events/lance-armstongs-statement-of-august-23-2012

So now I am finally free to write about Lance Armstrong with little chance of initiating a lawsuit, I find rather little of interest to say. Everyone had pretty much made their minds up one way or another anyway and I think the story had already been factored into people’s views about the Tour de France and doping. I suppose as a scientist a few things stand out that are still unresolved. Let’s assume that if Lance was doping – which I am sure he will deny to his grave – then he beat a lot of people who were also doping. Was he better at doping (possible)? In some strange way was his testicular cancer and its benefit in a real biochemical/physiological way (possible I guess, but the mechanism would be strange)? Or was he just head and shoulders above every one else in his talent, training and preparation that in anything close to a level playing field he would emerge victorious (I guess the most probable answer)?

As a scientist, I don’t think I can comment too much on the US Anti Doping (USADA) agency evidence. The case is after all predicated primarily on detective work and witness statements, not scientific analysis of blood or urine samples. We don’t have the fine details yet although USDA do say they will reveal it in due course; I really hope they publish it all for the good of the sport, including naming all their sources. I personally would like to know what was the basis for the following 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”. Clearly these cannot have been direct EPO tests or he would have been banned at the time. Nor can they have been homologous blood transfusions (also detectable). They must be a version of the athlete hematological passport (which was later introduced by cycling). But on their own they cannot have been definitive it seems to me or more would have been made of them at the time.

So what now? I think my concern is less of what this means for Armstrong but more about the relationship between UCI (cycling’s governing body) and the world’s anti doping agencies. UCI tried to stop the USADA case and it is not clear that they will agree to Armstrong’s Tour de France titles being expunged. In return USADA pretty much accused UCI of corruption  - see http://online.wsj.com/article/AP65c10ede4cfb4303a1870a3d1c18200a.html. It will be a shame if, just as cycling appears to be heading for a “cleaner” phase, some of the momentum is lost with this squabbling. 

Talking to the media about doping at the Olympics

Largely because of the furor about the Chinese swimmer, Ye Shewin, I have spent a lot of time in TV and radio studios recently. My book, Run, Swim, Throw, Cheat is really about the science of doping now and what could happen in the future. But of course I get asked a lot of more general questions as well. I thought I would indicate the most common queries and my usual response:

1            What drugs do athletes use and do they work?

I usually answer this with the unholy trinity: anabolic steroids for power events like sprinting, blood doping for endurance events and amphetamines (or similar) to prevent fatigue. If pressed I say that the strongest evidence for benefit is using blood doping (whether transfusions or EPO injections) and anabolic steroids, especially in female athletes.

2            How many athletes dope?

Always a tricky one: I first state the number that test positive (0.5 – 1%). Although this could be an overestimation, as testers target the more suspicious athletes, I think it is more likely to be an underestimation. I usually settle on somewhere between 1 and 10% have tried doping in their career at any time. Nice and vague. Of course this number varies dramatically between sport and country. But I do think it is not a majority and we need to recognize that.

3            Who is winning the war on doping?

I always say this is impossible to answer - how would we know if the dopers were using an undetectable compound? But it is likely the dopers and testers are on top at different times. Given the identity of all elite athletes is known – and their number is relatively small compared to all criminals in the world – if enough money and police intelligence was thrown at the problem it would make it very hard for the dopers to succeed routinely. But maybe this money is better spent on building a new hospital or improving our schools instead?

4            Are athletes gene doping?

Although theoretically possible, like most scientists I think it very unlikely this is successfully being used at present. There are likely more effective, and cheaper, ways to cheat anyway.

5            Why not stop spending all this money in an unwinnable anti doping war and let athletes do whatever they want to succeed?

I answer this, by saying, that we should be careful what we wish for. The best example is anabolic steroid use in female athletes. Unrestricted use led to the health problems we say in East German athletes. We may not like the look of the competition we create. If we allow steroid use under controlled medical supervision we may have healthier competition for those obeying the rules. But there will still be a few who want to go further. How can we check this without an effective anti doping regime? The same system needs to be in place, just working with a different set of goalposts.  

5            Why not have an Olympics competition for “normal” athletes and another for those using whatever they can to be the best that they can be?

This is an easy answer. Some of the methods tried in the “doping” games would involve illegal drugs. Many of the athletes would live shortened lives in the pursuit of victory. Which competition do you think Coca Cola or McDonalds would sponsor? Which would the BBC or US networks cover. This kind of question is philosophically valid to ask, but practically a waste of time to think about. It ain’t going to happen.

I will be talking about this, and more, including my demonstration of blood doping using red wine, at the Edinburgh International Book Festival on August 27 (http://www.edbookfest.co.uk/the-festival/whats-on/chris-cooper).

Is there excessive doping at the London 2012 Olympics?

I am writing this blog near the end of the Olympics – but as I go on holiday in a few days I thought I would take the risk of summarizing my view of what has happened so far. The events started with a well-orchestrated bang as the International Association of Athletics Federations announced the banning of nine track and field athletes on the eve of the games. Three were caught when samples were re-tested from last year’s world championships. Six were banned based on the “athlete biological passport”.

Both the number of athletes and the nature of the tests were significant. The London anti doping laboratory will keep the athletes’ urine and blood samples taken Olympics for eight years. At any time in the future they can be re-tested. This has been done before; in fact there has been some controversy over how little was done with the Athens samples collected at the 2004 Olympics, the statute of limitations for testing of which is about to run out. However, recently some re-tests were ordered and amongst those caught were the Belarusian hammer thrower Ivan Tsikhan. In the case of London, I suspect the World Anti Doping agency will be much more aggressive.  They have collected more samples than ever before and – uniquely – have stored the data in a way designed to capture the molecular fingerprint of as many unknown drugs as possible. I think it is now very risky to use a previously undetectable or unknown drug at the games itself; all potential medalists will be tested and eight years is a long time to keep a secret. We have seen before with the US BALCO scandal when a disgruntled coach sent a syringe of the undetectable steroid to the US anti doping agency, there is little honour amongst thieves.

However, testing at the games is only one part of an effective anti doping strategy. Out of competition testing, both random and targeted at suspicious athletes, is key to catch athletes who can get benefits from drugs even if they stop taking well before the games themselves. A new innovation is the athlete biological passport. This aims to take regular snapshots of an athlete’s metabolism via urine and blood samples to see whether there are any suspicious changes that might indicate doping are occurring. In principle an athlete can be banned via this indirect “smoking gun” even if no actual banned drug is found in their body. At present this is limited to detecting blood doping, but it is hoped to extend it to hormonal markers that might include human growth hormone and anabolic steroids. Bans have indeed been implemented in cycling and track and field athletics. I believe that combining aggressive use of the passport in a small cohort of registered elite athletes with holding all samples and data for eight years would make it prohibitively difficult to cheat by doping. But the cost of such a program would make it impossible to implement in all Olympic sports.

So what has happened at this year’s games? As many have said before it is rare to catch someone at the games itself (why dope when you are almost certain to be tested?). So there has been the usual procession of “dopy” dopers i.e. people who are just bad at cheating or cheat by mistake. One athlete fell foul of the same steroid, stanozolol, that Ben Johnson was caught using in his infamous 1988 100m race. Perhaps the doper hadn’t read his history? Another ate a brownie before he left for the games that he claimed someone had laced with marijuana. Thanks mate!

But the real controversy has been about commentators (including those on the BBC) and some coaches (step forward John Leonard) implying people had been doping simply due to posting a fast time. For reasons I have discussed elsewhere this approach is fraught with danger. In the case of the Chinese swimmer, Ye Shewin, there is a really nice statistical discussion on the BBC web page that shows her time, whilst outstanding, is not so unusual that it should trigger accusations of doping (http://www.bbc.co.uk/news/magazine-19116749)

I will be talking about this, and more (including my demonstration of blood doping using red wine) when I discuss my book Run, Swim, Throw, Cheat at the Edinburgh International Book Festival on August 27 (http://www.edbookfest.co.uk/the-festival/whats-on/chris-cooper).