One of the interesting ideas that came out of the Doping Summit held earlier this week in Paris was that of creating a “biological passport” for each professional cyclist (or more likely, each cyclist on the ProTour teams, if the ProTour doesn’t implode on itself). The theory is that by keeping track of various hormone levels and biological markers, that over time any cyclist who might be doping will have changes in their test results, which could be used to determine whether an individual was doing some sort of blood boosting, or steroids, or other types of performance-enhancing drugs.
It sounds like a good idea, as long as the program is structured properly. The concept seems pretty solid: Rather than testing for the drugs, why not test for the drugs’ effects? Great idea. If taking steroids means that luteinizing hormone (LH) and follicle-stimulating hormone (FSH) will not be as prevalent in a person’s body, then wouldn’t it stand to reason that lower levels would be proof of doping?
Well, no, it wouldn’t actually. What it would do is raise a red flag that says, “Hey, here’s something we need to look into further.” Like the program that the Agency for Cycling Ethics and Team Slipstream (powered by Chipotle) have implemented. A change in an athlete’s biological indicators, in the ACE/Slipstream program, requires further investigation. Could be doping. Could be a response to something else. Could even be an indication of a medical condition that needs attention. The point is, that a change in these levels isn’t direct proof of anything, other than a change in these levels.
And that’s where I’m afraid the UCI’s new program will go wrong. The idea is good, if they use it as a basis for more focused testing, but not if they take the approach that they will use this program instead of more direct testing for drugs. What they need to do is use both techniques, rather than either one exclusively.
What also gives me pause is the question of who would do the testing. Given the unevenness in quality controls at various WADA-certified labs, if I were a rider at that level, I’d be very leery of those labs doing these tests. Instead, I’d want to see the testing done at medical laboratories that meet the proper certifications for the various testing procedures and protocols they employ. I’m also leery of the WADA-certified labs because I’m not sure that they have the staff to handle the volume of work necessary for the UCI’s new program.
The Landaluce case is a good example of what happens when a lab is short-staffed. Whether Landaluce doped or not, I don’t know. But his case was thrown out because the same person was involved in testing both his A and B samples, which is a violation of the international standards for labs (ISL), and very likely an ISO violation as well. While it may seem like a mere technicality, the principle is that someone should not be in a position to be verifying their own work. There’s a natural bias that occurs, because the technician knows how things came out the first time, and he or she wants to make sure it does the second time around.
The point of verifying the work, however, is to make sure that no anomalies in the way that work was performed led to the results reported. If another person is able to repeat the results, the results are more believable. Not necessarily correct, as it’s possible that a systemic problem within an individual lab could lead to wrong results. Which is why it’s preferable to have a separate lab verify results. If two labs can get the same results, the data has even more credibility.
When it comes to the WADA-certified labs doing the biological passport work, consider this: If an anti-doping lab doesn’t have enough people to be properly staffed with their current workload, how much more swamped would their lab rats be under the UCI’s new program? And how would that affect the quality of the work? Not well, I suspect.
While the UCI’s idea for creating biological passports may have some potential for rooting out real cheaters, what will determine the program’s effectiveness is the way it’s implemented. It’s not just a matter of which tests to perform, and which data to analyze. What is also needed is some clear-headed thinking about how to proceed when the data suggests an athlete may be cheating. The program shouldn’t lead to a prosecution, it should lead to more focused testing to determine the cause of the changes.
If — and only if — those changes can be properly attributed to doping (and not natural variation or an underlying medical condition), then it’s appropriate to start anti-doping proceedings. Which still leaves a need for better and more accurate tests to detect the drugs, because sooner or later a fair system wouldn’t just prosecute someone for indications of using steroids, it should prosecute that person based on very specific evidence.
Biological passports aren’t the whole solution to the problem of doping in cycling. Properly implemented, however, they could be a start in the right direction. The biggest question I have is this: Can we trust the UCI to put together a coherent program, and can we trust them to execute it appropriately?
Maybe they’ve got an ace or two up their sleeves, but right now I’m skeptical as to whether the UCI can pull this off.
Does it surprise anymore that when the “governing bodies” decide on a “new test” to control doping — they pick one that turns out to be another test that leaves itself to “subjective” interpretations? Meaning — “well, this test indicates a change — we don’t know what change — but we choose to interpret it as doping.
As Rant points out
> “Could be doping. Could be a response to something else. The point is, that a change in these levels isn’t direct proof of anything, other than a change in these levels.””I’m also leery of the WADA-certified labs because I’m not sure that they have the staff to handle the volume of work necessary for the UCI’s new program.”
– And as we have come to learn — The various WADA Labs have no set standards for doing their work — in otherwords — two labs doing the same test – may be using different procedures, with FINAL and ultimate INTERPRETATION of the data falling to the Governing Bodies, who have consistently proved that they are only interested in having the POWER to come up with their own interpretations?
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Isn’t this the very same problems we are facing now? Do to WADA’s fast and loose rules, we may now be investing in anther case of — “Me WADA — You too dumb to know better.”
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Yet it seems that the new “blood-passport” is being publicly presented as having the power to “show doping going on” — How convenient for WADA and the IOC. They want all dopers burnt as witches — forget about the reality that WE HAVE confused and complicated testing — that are done in an unscientific manner — different labs allowed to use different protocols is far from being scientifically correct.
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So where are we now? RIGHT BACK WHERE WE STARTED. Maybe — It is all well and good that “We don’t want any doping going on!” — But to create another “test” that is a “-“non-specific indicator” is only going to cause more confusion. As Bill Hue said: “Follow the money!” — Well it seems the “money” is making possible once again to use their position to pound the Riders into mincemeat — With No hope for FAIRNESS.
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But hey — “The riders are all dopers anyway — if we don’t watch them like hawks — they will dope 100%” — well maybe they do — but we won’t ever find out for sure — not with the loaded regulations and subjective interpretations of testing that seems to be the “accepted” code of conduct being allowed to exist in the “Governing Bodies.” But hey — they like it that way, just fine.
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Keep EVERYTHING so inept — so confusing — so contradictory — we can “interpret” anything anywhichway we feel like it — AND FOR THOSE WHO BENEFIT FROM DOPING, they can navigate the confused murky waters—doping away merrily, finding the blank spots in the system. After all people — we wouldn’t really want to change”¦would we?
Many people believe that most pro cyclists are dopers. Stipulate that is true, and one conclusion is that most dopers are avoiding detection by current testing schemes. As I see it, there are 2 possible reasons that a cyclist is avoiding detection: 1. he is using some strategy in terms of what PED he uses, the dosage and timing of dosing such that he can show “clean” when tested, or 2. because in competition testing, at least, only a few riders are tested at any one given test. (BTW, I wonder about OoC testing, perhaps they gear that towards the top riders, or riders who are otherwise suspicious, so that a low-level rider, like Papp, doesn’t get much if any Ooc testing?). We have had a few cases of top riders who managed to avoid detection during much of their racing career, and then either confessed or were ultimately caught, maybe by OP.
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So UCI/WADA realize that there are some problems with their testing strategies. So they come up with this “blood passport” idea. An idea which has some potential good points, but there are a lot of questions about the actually implementation.
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This will require what are probably several orders of magnitude more tests being run on riders than currently are being done. Is the capacity of WADA approved labs great enough to do this. Remember, WADA labs test athletes from many other sports besides cycling. Is WADA and/or UCI going to come up with universal standards that all labs have to follow, both in terms of the types of tests that are run (to avoid a situation like the Mayo one) as well as the standards of practice used in conducting any particular test (to avoid a situation like Landis)? What access will riders be allowed to review their records at any point in time?
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It will be interesting to see what shakes out if this idea is really implemented next year. Will there be a large number of “dopers” detected and banned? Or will there be few riders caught? And if the later is the case, will that be because there really never were a lot of riders doping, or because most of the dopers stopped because of the new testing scheme?
The “medical passport” business is enormously complicated. Is this is a good thing or a bad thing, is this going to help cycling or make life even more difficult for cyclists? It all depends on the details of the program, and as best as I can tell, precious few of these details have been agreed upon. They just seem to have agreed on a cool name for the program: “medical passport”.
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There are thousands of details of a medical passport program that have not been worked out. Rant has mentioned a number of them. I’ll throw out two more: who is going to pay for all this, and how are you going to run such a program consistent with the strict European and American laws governing medical privacy?
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I’ll try to post more on these issues later.
Larry:
The privacy issue might be dealt with via the athlete’s waver, either explicitly stated or implied as a condition of receiving a pro license. Sort of like many states have regarding consent for testing for DUI. Probably the best way would be an explicit waver detailing the sort of information that would be included in this “passport” and how it would be used, so that an athlete could make “informed consent”. Of course, there would need to be proper safeguards to ensure that confidential info was not made available to the general public, only to those with a “need to know”. And therein lies a big problem: there is a problem even now with leaks. WADA/UCI has shown little desire to deal with this situation, perhaps because they see the leaks as helping their agenda. They really need to nail down the leaks and get them plugged up.
William, I promise I’ll look at this more carefully when I have time. But I believe that under U.S. law, no waiver of medical privacy is permanent. All can be revoked. Which raises interesting issues in connection with a medical passport system, which relies on historical data and not merely on information contained in a single sample.
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Also, you cannot waive your right for medical records to be kept in a secure manner, even if they’re never leaked.
Larry:
It wouldn’t have to be a permanent waiver, just for one year to be renewed when a rider renews his license. Of course, you could revoke it at any time, but of course, then UCI revokes your license! And I wasn’t suggesting that the records should not be kept secure, just that at present there is a problem with that that needs to be addressed before attempting to compile a record system such as this.
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It sort of sounds to me in general that UCI may be getting in over their collective head here, at least as far as actually implementing a workable “passport” program for the upcoming season. There are many questions to be answered about how the program should and will work. I think that perhaps what needs to be done first is some sort of trial run. But I’d bet that UCI will be willing to jump in the deep end.
I think that the real problem is that there is no data that shows how a particular rider’s natural blood work changes over time. How many long term studies have been done on elite athletes regarding this type of information? Does anybody know what to expect over time from someone like Saul Raisin versus someone like Victoria Pendleton? How is their physiology affected by fatigue, travel, crappy French hotels, eating Taco Bell for two months while on the road, or living in a cheap unheated apartment on the north side of Termini Station in Rome?
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Without a high level of physiological information (perhaps beyond what science can accurately provide) and a high level of lab competency (which we know doesn’t currently exist), this system is dead on arrival. The whole thing sounds like a political solution where intentions are more important that results. Am I supposed to be impressed by their good intentions? Let’s see if we can just get the rudimentary requirements of the current system to work.
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The past few months leads me to believe that the blood passport system could be used to eliminate “undesirables” without just cause. Say Rasmussen has an odd change in his Hematocrit (say a jump from 44 to 48 due to training in the Himalayas with a bunch of Buddhist monks riding unicycles) – would WADA or the UCI leak this his information to the press then conclude that he should take a de facto suspension until he can prove that this change was natural? What are the specific rules that would govern the dissemination of the information within the passport? What rules would govern how this information is used as a tool to control doping?
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Perhaps this is a system that should be wholly administered by the teams. Not the governing bodies. After all, a team and the sponsors have a lot at stake if a guy tests positive (just ask Phonak, Mapei, Mercatone Uno, Astana, or Festina). This information could be used very effectively by a team to avoid a positive test by one of their riders. The governing bodies should just clean their own house and manage the useful testing procedures more effectively.
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Maybe. . .
Teams are doling it now. They are collecting data on their riders — Collecting is not the hard part. The difficulties start when you are trying to find which points are what. I believe the doc who is now establishing his own “testing house” — who headed the UCLA facility, said as much when he was interviewed. He said that the blood passport idea is the right place to START.
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Yet you got the “blood-passport” idea being touted to be the 11th wonder and the sure way to “control” the cheaters. It concerns me and raises questions. I don’t believe it matters “who” sits in Dickey’s chair — the people who pull those set of strings already have this planned out to sell.
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I do not like feeling like I am being pushed into a corner — but I ask you — how on earth can they hope to get away with — playing at a stunt like this? How is it that there is absolutely no action against LNDD? What if LNDD just turn out to be the lab that is working out the test parameters”¦I cannot imagine a darker nightmare. But as you all by now know — certain promoters hinted strongly that the “blood-passport” will be their barometer for whoever is to race the Tour”¦
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So let me get this straight — LNDD is “doing a rush job” on HAMMERING OUT THE “blood-passport” criteria of testing — ASO — knows that the “LNDD Team is on the job” and he has an “iron-proof” way of keeping the Tour clean”¦Unless of course we don’t know important aspects that have been “secretly being conducted” — to protect the “Athletes privacy rights”¦”
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Yeah — right”¦.
Well it is about time! Bonnie D. Ford from ESPN has finally got it into the mainstream media (?) >”And none of the agency heads are addressing the elephant in the room: the French laboratory that continues to leak test results with impunity and that was scorched for sloppy procedures in the Landis case. It’s not enough to say that the underlying science is OK. Any lab with WADA accreditation needs to be above reproach.”
Regarding the medical passport program, I’m going to put the medical privacy issues to one side for the moment. These issues are completely unclear to me even after some research, and this is actually an area of law I know something about. Under U.S. medical privacy law, any waiver of a person’s medical privacy rights is revokable, though the effect of that revocation is unclear. It’s also not clear whether an employer can retaliate against an employee’s revocation of a medical privacy waiver. In a situation like this one, where the data is going to be held somewhere in Europe … I don’t even know where to begin trying to figure out how the medical privacy laws here and there are going to work.
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In any event, the medical passport program is going to be a big, big deal. We’re going to be talking about it for a long time. And it’s probably going to take a long time to put this program together. It’s an expensive kind of program, and I don’t see where the money is going to come from. Moreover, the regulations for a medical passport program are potentially much more complicated than what’s been needed up until now: rather than describe an absolute doping threshold (like a 4:1 T/E test), you’re going to need to develop thresholds based on changes over time in multiple biomarkers. How do you describe in advance all of the combinations of changes in these biomarkers that might or might not indicate that an athlete is doping? And (as Michael pointed out) how are you going to come up with the science to back up the regulations?
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Expect that one of three things is going to happen. (1) The program will collapse, or be postponed for a number of years. (2) The program will be implemented, for PR purposes if for no other reason, in a limited and largely meaningless way, while the powers that be gear up to spend the money, do the research and develop the rules required to do it in a more significant way — probably in a few years. (3) The ADAs will require the medical passport programs to be run by the teams themselves, under vague and fuzzy guidelines published by WADA or someone like WADA.
I’d bet on #2, with the possibly that they might at least try over time to phase in a more meaningful program. I don’t see that there is any way they’d be able to work out all the details or meaningful program in the near future. Of course, they are sort of committed to something. I’d doubt very much that they’d let teams run anything official although of course there are teams now doing something of the sort, and maybe more teams will join the program over time.