Dope Springs Eternal

It’s been a while since last I posted here on the original RYHO.  Over the last week, I’ve been participating in what might best be described as the “Office Cleaning Olympics.”  The OCO is a grueling endurance event, which tests the stamina and determination of even the best. But it’s an equal opportunity sport, too. Anyone can participate at any time. All it takes is an office that needs to be cleaned, reorganized or otherwise whipped into shape.

So now that the office is in tip-top condition, it’s time to get back to fun stuff. Like ranting and raving about doping in sports. Two stories caught my eye last week, in part due to tips from this site’s faithful readers.

The first would be the Court of Arbitration for Sport’s decision upholding the two-year ban imposed on German speedskater Claudia Pechstein, who wins the dubious honor of being the first athlete to lose a case based on the new biological profiling system before the Supreme Court of Sport.

Based on an elevated reticulocyte count at a competition in Hamar, Norway in February 2009, Pechstein was accused and is now banned for alleged use of blood doping. Based on the CAS’ press release, the following table shows Pechstein’s measured reticulocyte values:

So what is a normal reading for reticulocytes in a woman’s blood? According to WebMD and Yahoo! Health (which appear to either repeat the same information, or have very similar information), the normal range is 0.5% – 2.5%. Both sites list a number of reasons that values could vary from what is considered normal. One possibility listed is a blood transfusion. No mention is made of athletes using EPO, but that could be another possibility.

In their press release announcing the Pechstein decision, the CAS noted the following about the athlete’s defense:

Claudia Pechstein and the German Speedskating Association (DESG) both filed appeals with the Court of Arbitration for Sport requesting the annulment of the ISU [International Skating Union] decision. Ms Pechstein put forward that she had not violated any anti-doping rule and contested that the percentage of reticulocytes values measured in Hamar were the result of the application of a prohibited substance or method. The athlete asserted that the upper limit of 2.4 in percentage of reticulocytes referred to by the ISU is not a generally accepted limit in medical practice. She stated that her high values were due to a blood disease. She also considered that the data collected by the ISU on the basis of blood screening were unreliable and unlikely to be of statistical or medical value for a number of reasons, such as cold temperature, altitude, physical stress due to intense exercise, foot pressure due to ice skates and blades, bleeding and an infection incurred in January 2009. Finally, the athlete expressed the view that the machine used for the blood analysis was subject to substantial fluctuations if it was not properly calibrated.

From both the WebMD and Yahoo! Health pages, the upper limit used by the ISU seems believable. But given that the biological passport system is a set of indirect measures, her results could be caused by a number of other things. Yahoo! Health notes that the following could be reasons for a higher reticulocyte count:

A high reticulocyte count may mean more red blood cells are being made by the bone marrow. This can occur after a lot of bleeding, a move to a high altitude, or certain types of anemia. These conditions cause red blood cells to break down (hemolysis).

The reticulocyte count rises after the treatment for pernicious anemia, iron deficiency anemia, or folic acid deficiency anemia starts working.

So at least some of Pechstein’s defense sounds plausible. And, if the infection the press release refers to was treated with a sulfa drug (Bactrim or Septra, for example), her reticulocyte level could also have been affected. The CAS panel, however, disagreed with Pechstein’s assertions. As their press release notes:

In summary, the CAS Panel has rejected the Appellants’ arguments related to the sample collection and the analysis procedure and found that the calibration procedure established by the manufacturer of the automatic blood analyser used by the ISU was reliable. Furthermore, the CAS Panel found that the percentage of reticulocytes values shown by the athlete in Hamar on 6 and 7 February 2009 constituted abnormal values in comparison with both the general population in Europe and other elite speed skaters, as well as in comparison with her own usual values. The Panel also found that the variations in the athlete’s percentage of reticulocytes from 1.74 on 8 January 2009 to 3.49 on 6 February 2009 and then down again to 1.37 on 18 February 2009 was abnormal.

The Panel found that the above abnormality could not be reasonably explained by the various justifications submitted by the athlete nor by a congenital medical condition, as the expert hematologist chosen by athlete examined her in depth and concluded that there were no signs of any detectable blood disease or anomaly.

Pechstein’s case, and any precedent set by it, will affect the course of other anti-doping prosecutions based on biological profiling in the future. While the biological passport/profile is a novel way of detecting the use of banned substances, the conclusions drawn from the data must be balanced against any other medical explanations.  Without an actual positive test for the use of EPO or its variants, and without an actual positive test for homologous blood doping, the anti-doping authorities enter into a world of speculation about what caused the results. On the surface, some of the explanations offered by Pechstein jive with easily referenced sources on the web. It’s not clear what evidence Pechstein cited in claiming that the machine used for the tests last February was properly callibrated or not. Whether her full defense (or what’s quoted of it in the panel’s decision) backs up her overall position, as stated in the CAS press release, may be a different matter.

I’ve not had time to read the panel’s full decision (yet), but Susan Westemeyer of CyclingNews.com apparently has perused the document. She notes:

The Court acknowledged that the speed skater had never tested positive for a forbidden substance. She had argued that if she had used EPO, a common doping product, it would have been found in a urine sample. The Court noted that EPO can only be detected within a few days of its use, and that the increased red blood cell production encouraged by the substance will remain long after traces of the EPO have disappeared.

“The Panel is also aware of sophisticated doping plans which provide for the frequent administration of very small doses of EPO, which makes it increasingly difficult to detect it in urine samples at all. Hence, the Panel does not consider the absence of a positive finding EPO to be evidence which could exclude blood manipulation.”

In addition, the court said that “all experts acknowledged that … the haemoglobin and hematocrit levels may be manipulated quickly and effectively by quite simple methods of hemodilution.” Further, “there are easily-operated machines that athletes may use to constantly check and keep under control the levels of haemoglobin and hematocrit, thus avoiding the no-start sanctions connected with high values of those blood parameters.”

You can find full 63-page write-up of the CAS panel’s decision here.

Meanwhile, back at the ranch …

Another Spanish doping investigation came to light this week, dubbed Operación Grial (Operation Grail), with at least 11 individuals arrested for being part of an organized doping ring. As CyclingNews.com reports:

The [Spanish] Civil Guard … revealed details of the activities of the alleged doping ring, which they say include the distribution of EPO, growth hormones and masking agents.

“During the investigations it was discovered that among the network of members was a physician with sports and dietary consultation in Valencia, whose role would be to prepare training plans, nutrition and supplementation aimed at improving the performance of athletes, including substances in these plans prohibited in sport.”

Various Spanish media sources have identified Peruvian physician and former Kelme team doctor Walter Viru, and Contentpolis-AMPO cyclist Pedro José Vera as two of the individuals who were detained as part of the operation.

This is not the first time that Viru’s name has come up, according to an article at the Daily Peloton.

Amazingly, former Spanish professional Jesus Manzano (ex-Kelme) has said that he actually warned the Spanish anti-doping authorities about Viru and his role in helping cyclists to beat the doping controls.

Speaking to French newspaper L`Equipe in 2007, Manzano said: “I want to give you an example, something I’ve never spoken about except to the police up until now. It concerns one of the four Spanish Laboratories accredited by the UCI. This laboratory, which is in charge of sending the UCI vampires [doctors] to take the samples during the Vuelta and other races is the same lab that’s in charge of the doctors’ visits to the cyclists. They follow the cyclists and give them the stamp of approval on their licenses.

“The owner of this clinic, a renowned haematologist, called Walter Viru, who is one of the doctors for Kelme, warned the team doctors the day before the UCI vampires were coming to take the samples from the cyclists. And he did the same thing with Del Moral, the doctor for the US Postal team and then Discovery, [who is] a good friend of his.”

If Monzano [sic] is to be believed, that means that at least one of the actual clinics that the UCI has working for them in the fight against doping is in fact helping the cyclists to cheat the doping controls.

And then there’s this brief article claiming that Austrian police have uncovered a network that was supplying growth hormone to athletes.

To paraphrase an old saying, dope springs eternal.