Ammended, February 2013

A few weeks ago, Lance Armstrong confessed to using doping methods to achieve his victories, surprising almost no one, at least within the cycling community. He did however deny that there was any doping during his comeback, which includes the blood values descrbed in this article.

Despite my reservations I originally wrote (which are below) on interpreting his blood values as a positive, I don't believe that he's being truthful. In my opinion, he was more likely blood doping than not during this time.

My understanding of the bio passport program and the factors that influence their values has improved significantly in recent months. If I rewrote this article from scratch I would significantly strengthen my description of how consistent his blood values are with doping. But I'm not going to bother. Just watch this video. It's the (sort of) opposing viewpoint to mine below, but it's a compelling argument.

I stil have reservations about interpreting positives from the bio passport program. I still think it's possible to find a reasonable explanation for Lance's blood values from 2009 that do not involve blood doping. However, I do not consider any such scenario likely now.

The latest revelation, that came out just today, is that (despite assurances from the UCI), Lance's blood was never examined by the bio-passport panel. This may be related to overly-simplistic software that failed to kick Lance's blood out for additional review. But given the attention that his blood values received at that time in the press, I can only think that the UCI was negligent in their anti-doping efforts, and possibly was involved in an intentional coverup.

I've also come to understand that the bio passport program is one of the most powerful tools available for anti-doping so far. Even though it is not an ideal tool for generating positives and sanctions, the great thing it accomplishes is to limit the degree to which dopers feel that they can cheat without being noticed.

It's my belief that this approach, rather than traditional positives and sanctions that we've used in the past, is the future of a successful anti-doping program. Fear of sanctions has not been much of a deterrent, but the need to evade tests leads to substantive changes in doper's behavior. The result of a steadily improving bio-passport program will be that over time dopers must spend increasingly large amounts of money evade tests while achieving steadily diminishing results. Changing the economic equation for dopers is a far more powerful tool than sanctioning.


Ammended, June 2012

For the record, I now believe that Lance Armstrong used doping methods to achieve his victories. I've actually felt reasonably convinced of this since Floyd Landis and Tyler Hamilton stepped forward two years ago. I've always believed that someone like Lance naturally accumulates some enemies, and that you'd need to meet a high standard to rely on witnesses. For me, Tyler and Floyd reached that point. Not just because I believe them, but simply as a matter of quantity. Prior them there was already what I would call a worrying quantity of evidence from the "haters".

With the newest revelations, most insiders seem to expect there will be several reputable names added to the list, which for me eliminates any lingering doubts. While some seem willing to discount witness testimony, and prefer analytical (blood, urine, etc.) testing, I tend to believe that a critical mass of witnesses carries far more weight than any testing. Most of the tests in use today, particularly those which test for things that are natural on their own, use subjective standards or methods, and can easily be doubted in any particular circumstance.

What I wrote below, I mostly stand by. I will continue to be critical of the biological passport if it is used to show any sort of short-term positive in doping. However, it still may be a powerful weapon in the anti-doping arsenal. If it is used in Lance's case to support witness testimony with noticeable changes in blood values, then it moves in my mind from an unreliable test, to reliable corroborating evidence. By itself, any change in blood values might be due to doping, or it might be due to some other biological factor. However if such a change is coincident with a time where witnesses say that doping occured, that coincidence can not be ignored.

Even though I remain critical, the biological passport program is clearly popular. One of it's chief advocates is Michael Ashenden. nyvelocity has two excellent interviews of him available, one from 2010 and another from this year.


Lance's 2009 Blood Values - Much Ado about Nothing

Recently Lance Armstrong published his doping test results in an effort to demonstrate that he's clean. I've said in the past, that doing this is probably a mistake, especially for someone like Lance, because someone is bound to come along and find this or that detail suspicious.

At any rate, we have this data from the Tour de France (extracted from a table available here).

Date Hemoglobin Hematacrit Reticulocyte Comments
7/2/09 14.3 42.8 0.5 pre-tour, in France
7/10/09 14 41.3 0.5 stage 7, 1st mountain day, Contador attacks
7/11/09 13.7 40.7 0.5 stage 8, 2nd day in Pyrenees
7/13/09 no tests rest day
7/14/09 14.4 43.1 0.7 stage 10, sprinters holiday
7/20/09 14 41.7 0.5 rest day
7/25/09 14.5 43 0.7 stage 20, Mount Ventoux

In this case the first one of note to rise to the occasion was Jakob Mørkebjerg, a Norwegian blood researcher. I first heard of the story at nyvelocity.com which has good coverage of the story. The one link they seem to leave out is a more recent article at cyclingnews.com. Dr. Mørkebjerg has made three major points about Lance's blood values. First, that his hematocrit and hemoglobin remain very constant throughout the tour, rather than dropping as expected. Second, that his highest hematocrits both occur after rest days, with the implication being that he could hvae added a bit of blood on the rest days, and third that his reticulocyte counts are low, especially in light of his steady hematocrit and hemoglobin.

Everybody knows your crit drops during a Grand Tour

Lots of things that everybody knows turn out to be wrong. In this case, I make no claims. But that cyclingnews article mentions a study where this was demonstrated. The study involved seven athletes. Maybe it was a tour that was hot at the beginning and cooler later, in which case hydration issues would cause an apparent drop in crit during the tour. I'm not specifically making this claim, I'm just saying that I want to see a lot more data than one study of seven riders before making any conclusion at all.

And before saying that a lack of a drop is a sign of doping, I'd want to know how big of a drop is typical, and how much variation there is. For this kind of statistical data, which is absolutely required to draw this kind of conclusion, you'd need multiple studies each involving scores of athletes. Otherwise there's no statistical basis to decide what is normal and what is not. I admit at this point that I haven't done any research here. I have no idea of the number or quality of studies out there on this subject. But presumably Mørkebjerg is familiar with the studies, and yet he only mentioned a single study with seven riders. It may just be what fit in the article, but it doesn't inspire confidence.

I'd also like to know more about why the crit would drop during a tour. There are some obvious choices, but the mechanism would tell us more about how much control an athlete has at preventing this problem. Does the stress of a tour impact the die-off rate, the production rate, or both? If the production rate is affected, is the limiting factor something under nutritional control?

Increases in hematocrit after rest days

Recently I had the misfortune of having some medical issues, and had my blood drawn twice in one week. A complete blood count was performed in both cases. On Monday, my crit was 47, and on Thursday it was 43. The doctor was neither surprised nor concerned. There was no reason to suspect any actually loss of blood or red blood cells. My assumption is that this difference is attributed to hydration, because on Sunday I hadn't been drinking enough, maybe only 20 ounces or so. The rest of the week I spent in my maximum hydration mode that I use for illness, probably 80-100 ounces of fluid every day. There were no other issues like diarrhea that would have had a larger impact on my fluid levels.

Whether you like my hydration assumption or not, the fact that crit can change that much in four days without my doctor thinking it's significant says volumes about what these numbers mean.

In the entire month of the tour, the difference between Lances highest and lowest values was 2.4. Again, if mild dehydration accounted for my crit changes, just simple randomeness of hydration - when did Lance last pee and drink, how much is he sweating - could account for the variations we see. So on the issue of increases in crit after rest days, this data lies completely within the measurement noise. And because of the very small changes, it would certainly be hard to argue for any kind of useful or measurable performance gain from such a small increase in blood values.

But even so one has to wonder what the natural effect on hematocrit is from rest days. Certainly the obvious result during a rest day would be a drop in crit: your body no longer has all that waste to flush, and one presumes the athlete hydrates well, so the body will retain more fluid. This retained fluid translates into a larger blood volume without any increase in red blood cells. In other words, a lower crit. But then after another hard day of riding, does the crit jump back up to pre-rest-day values? Does it take a couple of days to return to those values? Or does it have an extra-quick rebound as the body is fully hydrated and willing to release fluids more quickly? I don't know the answer, but the point is, I'd hardly be surprised to see some influence on normal crit values from a rest day.

Reticulocytes

Reticulocytes are new blood cells, and the measurement is the percentage of his blood that is new. It's no surprise to see a low value going into the tour - he was coming off of high-altitude training, and presumably his body had already produced all the red blood cells it needed for altitude. After returning to lower ground, he would not be producing many new red blood cells, and the reticulocytes would be low. Really though his crit isn't very high for someone who had been training at altitude.

For the lack of attention this one has gotten, for my money it's still the most interesting of the three arguments. This probably says more about how uninteresting the other arguments are. At any rate, normal reticulocycte counts are around 1%, but with a lot of variation.

So the most interesting bit is that his reticulocytes are consistently low and yet his crit doesn't drop. Still, this isn't much of a sign of doping with crits this low. And, we have five days of tour blood values, meaning we don't know what his reticulocyte count looked like the other 17 days.

Red blood cells are produced in the marrow, and the body can request an increase in production by producing EPO. This tells the body to produce more red blood cells. But it also tells the body to release the cells that are already in production, even though they may not be "ripe". So it's entirely possible, even normal, to see a higher reticulocyte count for a few days, followed by a lower-than-normal count for a few days. It's a good argument for testing some of these blood parameters every single day during a tour, so you could actually make some meaningful statements about how the blood is trending.

Conclusions

There's nothing here that screams "doping". There are things here that seem slightly different from an ideal profile. It's unclear exactly what normal should be, and exactly how slight these differences are. Until someone is willing to cite studies and talk about the odds of these slight variations occuring naturally, this all amounts to nothing. If someone wants to pursue this to the last detail, they might try to answer some basic questions: Which samples were taken before the stage, and which after? What kind of stage was ridden that day and the day before? What kind of weather conditions? How did Lance perform? In my opinion, even that is a waste of time. There's no way to account for a rider doing a better job of hydrating one day versus the next, simply because of perception of thirst, or mood. There's no way to account for random luck of the body in how the electrolytes are balanced one day versus the next, and how that affects fluid retention.

There's no way to account for the fact that there's always some complex natural variation that for any practical purposes might as well be considered random.

If there's a study out there that says that 99% of tour riders see at least a five point drop in their crit during Grand Tours, then I make take another look. But I'm pretty sure that doesn't exist.


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