The Health Tests

ARTICLE SUMMARY:

  • In its comments about the health tests, the CIRC is unwittingly giving support to the cheats that tried to justify their doping with EPO.

 

 

 

FULL ARTICLE:

The CIRC comments on the health tests on pages 34-36 and pages 116-118 of its report. I analyse their comments below.

In January 1997, the UCI introduced a no-start rule based upon a health test: a rider who showed more than 50% (47% for women) haematocrit in his blood failed the health test and was then banned from competing for two weeks, as there was a risk to his or her health. There was no evidence of doping, as if there had been the anti-doping rules and anti-doping sanctions could and would have been applied. It was an interim measure, implemented during a period when a test for EPO was repeatedly predicted to come, but never arrived.

The health test also provided useful information about the blood profiles of riders and was used to target riders for anti-doping testing, especially when hemoglobine and reticulocytes were also analyzed as additional blood parameters. This important aspect is totally ignored by the CIRC: the health test system was in fact a forerunner of the blood passport.

The CIRC had at its disposal all of the information about how and why the UCI introduced the health tests in January 1997: it was an episode in the time when laboratories were searching for a method to detect EPO. The CIRC completely ignores this context, probably because it would have shown how the UCI participated fully in the research for an EPO detection method and was committed to have a reliable test at its disposal as soon as possible.

Brushing aside the context which would have reflected favorably upon the UCI under my presidency is a constant in the CIRC’s “methodology”.

 

The CIRC’s false start

Instead the CIRC focuses on the sudden death of a number of young riders (“perhaps 20” it says) in the years 1987-1990, so seven years before the health test was introduced (page 116). Why not “perhaps 30”?   On page 34, the CIRC more correctly refers to “media speculation” and actually references some sources.

This is not the only time that it seems to me that the CIRC report was written by different assistants, apparently selected by Ulrich Haas, without being proper checked by the CIRC President and also without any proper final editing of the report. In other chapters on this website, I identify a number of other contradictions and inconsistencies in the CIRC report which may be due to the same problem.

I cannot exclude the possibility that riders died from using EPO, but I have no evidence. What I do know is that, at that time, the sudden death of Dutch riders was investigated. The only cause that could be identified was cardiac dysfunction; in other cases, no cause could be established.   If it had been established that a rider died from using EPO, even if only a single case, it would certainly have been made public. For the rest, I find it very inappropriate (and not respectful) to continue to speculate about the cause of the death of these young athletes.

In 1993, the UCI asked National Federations to set up cardio-vascular examinations for young riders. It contributed half of the funds for a pilot study in Belgium and the Netherlands. In 1994, the UCI introduced a detailed cardiovascular questionnaire for the riders to fill in when applying for their licence. In 1999, the UCI introduced medical monitoring for trade teams, including cardiac screening.

The poor “quality” of the CIRC’s investigation is also illustrated by the following sentence: “furthermore a number of cycling-specific aspects acted as a driver for the proliferation of EPO, such as the high mobility of riders (constant change between teams), the similar professional and cultural background of riders at the time (with reference to note 190: cycling in the 90’s was still very much a European sport) and the fact that the cycling community was a rather small and a closed shop”.

Not only is there no explanation for the alleged influence of each of these elements on riders’ use of EPO, but I also fail to see why these aspects would have had a specific influence on the use of EPO compared with any other doping substance used by riders.

And how does this sentence fit in with the CIRC’s view that “EPO was a challenge for almost all sectors of sport although it was cycling that most often came under the spotlight” (page 95)? And does this include continents other than Europe?

 

The context: successive announcements of a detection method for EPO

In May 1992, the IOC announced that there would be no blood testing to detect EPO at the Barcelona Olympic Games: apart from the legal and religious problems with obligatory blood sampling that were acknowledged, there was simply no reliable detection method for EPO. From 1992, Professor Francesco Conconi and his colleagues at the University of Ferrara worked on trying to find a detection method at the request of the IOC. In a letter dated 21 June 1993, the IOC asked the doping laboratories to collect blood samples, indicating that there was a possibility that EPO could be identified from the concentration of transferrin receptors.

The UCI decided to join this initiative and, in a letter dated 22 September 1993, asked the National Federations and the team directors to collect blood samples for research purposes.

Also, in August 1993, the UCI’s Anti-Doping Commission requested from the labs that the total concentration of EPO (natural plus recombinant) be communicated to the UCI, under the incorrect assumption that sooner or later the total concentration could be indicative of the use of recombinant EPO. When it became clear, soon afterwards, that this was not going to be the case, the request was abandoned.

At the same meeting (in 1993), the Anti-Doping Commission decided to introduce out-of-competition tests – not in 2001, as the CIRC falsely writes in its report.

At the meeting of the UCI’s Medical Commission, on 12 November 1993, Professor Conconi explained that, for the moment, blood samples could not be used for the detection of EPO, as it was not possible yet to determine a concentration for a large population that would be indicative of blood manipulation. This is important as it shows that the scientists were thinking in terms of population-based criteria, not individual criteria: the latter were introduced not earlier than with the athlete blood passport in 2007.

Professor Conconi also reported on the advancements of the EPO research projects to the IOC Medical Commission on 12 February 1994 and to the UCI Anti-Doping Commission on 11 March 1994.

On 8 December 1994, the UCI organized an anti-doping seminar in Geneva with a number of specialist professors. A round table took place on the theme ‘The detection of EPO’.

On 18 March 1995, Professor Conconi announced that his laboratory could distinguish natural EPO and recombinant EPO. However, it was a purely scientific method that could not be used for anti-doping samples as the analysis was slow, costly and not robust enough.

Also in 1995, Wide, Bengtsson, Berglund and Ekblom published a study showing the principle for discriminating natural and recombinant EPO. But it would take another five years for the scientists of the Paris laboratory to succeed in developing a method for applying this principle.

On 1 March 1996, Professor Conconi announced that the discrimination of natural and recombinant EPO had become possible with electrofocalisation. However the method still had to be confirmed. He hoped that the method could be published prior to the 1996 Olympic Games in Atlanta.

On 14 March 1996, AFP announced that Professor Brisson of Canada and Professor Audran of France had developed a method to detect EPO in the blood: just one drop of blood taken from the finger would be enough.

In view of these announcements, the UCI asked all IOC accredited laboratories in May 1996 to confirm whether there was a detection method indeed. They all replied in the negative.

At the Olympic Games in Atlanta, Professor Conconi presented another method to the IOC Medical Commission: it required one litre of urine and the analysis took one week…

In October 1996, the IOC announced that the urinary EPO test would be ready for use by the end of the year.

Noting that the various research projects that had been announced had not yet yielded a workable EPO test, the UCI was happy to accept a proposal dated 7 February 1996 by Professor Brisson from Canada to test a method that he had developed with a few other scientists, including Professor Audran, a leading French anti-doping specialist and who, in 2007, became one of the experts on the UCI’s blood passport panel. Professor Brisson had been working for several years on a method that was based upon the observation of concomittant changes in haematocrit and transferrin/ferritin values (tfr/ftn index) which, according to him, could discriminate between pathological and physiological conditions. He wanted to test this method on blood samples taken from riders participating in the 1996 Tour de Romandie and the 1996 Tour de Suisse.

The UCI also made a financial contribution of 30,000 Swiss Francs to this research project.

Riders resisted having blood samples taken at the Tour de Romandie, but eventually accepted it at the Tour de Suisse, some weeks later. The samples were taken by the Lausanne anti-doping laboratory that was also involved in the project.

It turned out that Professor Brisson’s method did not yield a practicable test that was robust enough for anti-doping purposes, but it did provide useful information for other research projects.

It was also the experience acquired through this research project that inspired the introduction of the health tests by the UCI.

The experience was also important in that the riders had accepted blood testing.

Against the backdrop of all of these announcements of an imminent EPO test, which all turned out to be wrong, and with the experience acquired through the Brisson research, the UCI decided in January 1997 to introduce the no-start rule based upon a haematocrit test, the so-called health test.

All the information that I summarized here, plus all of the background evidence, was available to the CIRC, who decided to ignore it and to qualify all efforts of the UCI in the search for an EPO detection method under the heading “containment”.

 

The context: blood sampling

As indicated above, the IOC invoked legal and religious problems for not conducting blood tests at the 1992 Olympic Games.

In the 1990s, blood testing was not done. There were legal, ethical, religious and health (AIDS) objections. A study conducted by Browne, Lachance and Pipe in 1999 (“The ethics of blood testing as an element of doping control”, Med Sci Sports Exerc, 1999 Apr;31(4):497-501) concluded that in their present state of development, blood tests should not be implemented.

The UCI had asked riders to submit voluntarily to having blood samples taken at the 1996 Tour de Romandie (7-13 May) for the purpose of a detection method for EPO. The riders refused at that stage, but then accepted blood sampling some weeks later at the 1996 Tour de Suisse (12-21 June).

French anti-doping laws have authorized blood tests since 1991 (article 5, 2° of decree 91-837 of 30 August 1991), yet it turned out at the Festina trial in 2000 that not a single blood sample had been taken in France for anti-doping purposes.

 

The introduction of the health tests

The CIRC writes that “it was the various team doctors and managers who went to the UCI and begged them to start blood controls” as though that was the only (and decisive) factor that prompted the start of the health tests.

It was one of the elements, and an important one, to the extent that it showed a willingness to accept blood testing, something the teams and riders had still refused at the 1996 Tour de Romandie. Yet the CIRC focuses on this sole element, ignoring the UCI files where all of the facts could be found and referring only to the recollection of one person, Theo De Rooij of the Rabobank team, in an interview in 2014 (footnote 192 of the CIRC report).

This shows clearly that the CIRC avoided carrying out a comprehensive and objective investigation of the available evidence and instead selected only elements that fitted in with its biased approach of presenting a negative story.

Yet the idea to launch health tests came out of the experience gained from the blood testing undertaken at the 1996 Tour de Suisse (for Professor Brisson’s research project) and it was also proposed by Professor Conconi.

On 24 June 1996, Professor Conconi admitted to the UCI that he didn’t know whether and when he would find an EPO detection method. He then proposed an interim solution: carrying out blood tests to measure the heamatocrit level and then imposing a ‘rest period’ on any rider whose haematocrit levels exceeded a certain treshold.

All this led to the meeting on 24 January 1997 with scientists, representatives of laboratories, teams and riders that eventually agreed on a threshold of 50% and the no-start rule: if a haematocrit exceeding 50 % was measured, the rider was forbidden to compete for two weeks.

Viciously, the CIRC writes (page 117) that it was “this health aspect that made the UCI, and in particular Lon Schattenberg, step in”.    This is in line with the CIRC’s intention to depict the anti-doping program of the UCI as solely based upon a concern for the health of the riders and with tolerance of doping for the rest.

This is a totally malicious comment for various reasons:

First, of course the CIRC could not have written such a slanderous falsehood if (as might have been expected in a serious investigation) it had taken into account (all) the facts: the health test was a temporary solution implemented during a period of searching in vain for an EPO detection method.

The health test was evidently introduced to combat the use of EPO, but it could not be presented as an anti-doping rule because it could not prove a rider had doped using EPO. Therefore, it had to be presented in another way: a ‘health test’ rather than an ‘anti-doping test’.

The use of EPO increases levels of haematocrit in a body, but haematocrit levels are also increased by methods that are not forbidden,

such as high altitude training, the use of hypobaric chambers and “alti-trainers”, a device that lowers the oxygen concentration of inhaled air.

At the Festina trial, French rider Christophe Bassons, who claimed he was a clean rider and who generally was indeed seen as a clean rider (including by the CIRC: page 24), declared that he used an oxygen tent/hypobaric chamber to increase his haematocrit.

The haematocrit level is also influenced by exercise, metabolism, dehydration… (this is for example why the health tests were always taken early in the morning and also why blood sampling for an athlete’s blood passport is now subject to strict conditions, so that the values obtained are comparable).

The only possible approach was to decree that a haematrocrit level exceeding a certain threshold was considered to be a risk to an athlete’s health and required the rider to ‘take a rest’.

Second, what exactly is so wrong with being concerned about athletes’ health? 90 pages earlier, the CIRC wrote that “The use of EPO as a form of doping is particularly dangerous in lengthy cycling races” (page 33), “To the extent that the [50% haematocrit] rule served its purpose from a medical point of view, since it probably prevented EPO-related deaths, this was a commendable step” (page 36). On page 118, the CIRC accepts that “the health test may have protected the lives of riders”.   Add to that the emphasis eagerly laid by the CIRC on the “speculation that riders were dying from EPO overdoses” (page 35) and I do not understand the CIRC’s criticism and contempt for the health tests.

Would the CIRC have preferred that the health test had not been introduced? Or does the CIRC simply feel ‘obliged’ to criticise the health test in order to avoid giving the UCI any credit? Was the health test wrong because it was introduced by the UCI under my presidency, no matter how many riders might, in the belief of the CIRC, have died from EPO?

Third, EPO was undetectable and that was certainly not the UCI’s fault. The health test was introduced to combat the use of EPO and at the same time the health risks that went with its use. Yet the health test could not prove EPO was being used, as an elevated haematocrit may have been caused by other factors than doping. So it was impossible to formalize the introduction of the health test as an anti-doping measure as it could not be justified on anti-doping grounds: the test could not prove doping had taken place.

Fourth, everyone refers to the ‘health test’, but perhaps it would be more appropriate to focus on the ‘no-start rule’. The consequence of an elevated haematocrit resulting from a health test was that the rider was prevented from competing for 15 days. This could have serious consequences, for example making it impossible to participate, or continue, in a big tour (see, for example, the case of Marco Pantani). The justification for taking this measure could not be doping, as no doping could be proved (and therefore no sanction imposed). Therefore the justification for the no-start was the health risk.   I wonder what the CIRC would have proposed as being a better solution, failing evidence of the use of EPO. The CIRC doesn’t tell us of course. It is much more easier to criticise others than to offer an alternative solution to a very difficult problem.

Fifth, the CIRC contradicts its own subtitle on page 34: “health and safety measures to counteract the absence of an EPO test”. This is what the UCI did! It took all measures possible under the circumstances, in the absence of an EPO test. Under this heading, the CIRC recognizes that the health test were driven by anti-doping, but it was apparently not the CIRC’s intention to recognize that…

One the one hand, the CIRC wants to create the impression that it was at the insistance of riders, team doctors and team managers that the UCI introduced the health tests. Similarly, the CIRC writes (on page 35) that the the “Commission was told that the UCI had originally sought a 53% limit, but riders wanted to set the limit at 50%” (Note, too, that it is enough for one anonymous source to tell something perceived or presented as negative about the UCI for the CIRC to note it in its report as an established fact). On the other hand, the CIRC describes (on page 117) with a perverse delight how riders and teams adapted a technique to stay below the 50% radar so that they could continue to use EPO. Isn’t that a bit contradictory? For the CIRC, that is not a problem as long as the contradicting statements are both negative for the UCI, which is clearly the only constant in the CIRC report.

 

The criticisms of the CIRC

The CIRC comments about the limit being set at 50%.   I can’t remember all the arguments put forward at the 24 January 1997 meeting which resulted in a consensus around 50%. I am not a medical specialist either. When I consult the internet, the upper reference values for males vary between 51% and 53%.

Let me instead refer to the conclusion of the following article by Martin, D. T., Ashenden, M., Parisotto, R., Pyne, D., Hahn, A. G. (1997). ‘Blood testing for professional cyclists: what’s a fair hematocrit limit?’ in Sportscience News, (Mar-Apr), http://www.sportsci.org/news/news9703/AISblood.html:

The decision of the UCI to test the blood of professional cyclists to deter the use of rhEPO is admirable. However, the 50% hematocrit limit appears too aggressive on the basis of 10 years of data collected from road cyclists tested at the Australian Institute of Sport. A 52% hematocrit limit would result in fewer false positive tests and could still deter the suspected use of rhEPO. While elite athletes wait for sensitive rhEPO detection techniques to emerge, measurements of hematocrit may represent a temporary deterrent. However, prior to implementing blood testing for hematocrit it would seem worthwhile to carefully evaluate the cut-off level and also consider the influence of body position, altitude training and dehydration on hematocrit values in professional cyclists. It is now possible that the leader in the Tour de France could be prevented from competing in the final stage because his hematocrit is « dangerously » high. With lucrative salaries at stake, it will be interesting to see if the 50% hematocrit rule will last throughout the 1997 professional cycling season.

Of the article’s authors, I know that Michael Ashenden and Robin Parisotto are both blood doping specialists and experts consulted by WADA. However, the CIRC obviously thinks it knows more about the subject than they do. And forgive me for having emphasized the word “admirable”.

The CIRC seems also to criticise the “one-size- fits-all” limit. It is all too easy to say that now, with the biological passport in place and with all the science and computer modelling behind it that were not available in the 90’s. At that time (1996-1997), however, no one came up with the idea of introducing individual limits and indeed I wonder how that could have been implemented. How could we have determined the natural haematocrit level if riders that took EPO, or had an intention of doing so, could raise their haematocrit level through all kinds of means, including undetectable EPO so as to show a high “natural” level?   And how could we have determined for each one of them a limit above which there was a health risk?

It takes time to determine the natural values of an athlete and the CIRC, when reporting on the blood passport, describes itself how these values can be manipulated to stay within the limits. Also, the no-start rule was applied on the spot, before the start of the race: an individual value could have been applied only if the DCO knew what the expected maximum value was to be for a given rider the normal value of which had already been established.

So not all riders could have been tested for a no-start, only those for whom the natural value could have been established after a long period of time. For all these reasons, it has also turned out to be impossible to introduce a no-start rule based upon the biological passport. But the CIRC knows better, of course. The CIRC just condemns, without being hindered by mere trifles such as facts.

The CIRC writes on page 117: “It was clear from the beginning that this health approach had little deterrent effect on the misuse of EPO. It was only when the rule was first introduced that blood tests taken in-competition caused some concern to the teams”.   Another typical CIRC statement. I don’t understand what is so special with a rule having effect only when implemented. Note also that these vague statements are just statements and are not in the least substantiated.

The CIRC also writes that the riders were “quite often” warned of up-coming health tests by DCO’s and by a lab.   The CIRC gives no corroborting facts or details to back up this statement. I am not aware of that – and I wonder whether the CIRC has provided UCI with the necessary information so that UCI can investigate.

The CIRC writes a great deal more nonsense, based upon unverified allegations made by anonymous witnesses.

“The health tests were for the most part performed in the morning and were, thus, predictable”.   The health tests were indeed performed in the morning, and the CIRC seems to ignore all of the previously mentioned reasons for that. The tests were performed early in the morning, in order to avoid influence on the haematocrit of any physical activity and of breakfast. In this way, the values measured successively for the same rider were also more comparable and deviations more obvious.

Another “detail”: the health tests were the basis for the no-start rule. Personally, I see little use in applying a no-start rule in the evening, after a race. But the CIRC knows better, of course.

About the tests’ predictability: of course all riders knew that they could be tested. But that is always the case, especially today with the one hour time slot that athletes have to fill in on their whereabouts form. The riders had to reckon on being tested on any morning.

And the CIRC continues: “Little targeting took place. It has been reported to the CIRC that only those riders who were ‘exaggerating’ were specifically targeted, because they were a potential threat to cycling”.   I wonder how one could possibly know who was exaggerating with EPO if EPO was undetectable. But on the other hand, targeting those who were exaggerating (which means that, as was the case, the others were also tested) does not seem so inconsistent. And at the same time, the CIRC acknowledges that the UCI was seeking to take out from competition the suspect riders, notwithstanding the bad publicity that went with it (such as with Pantani, for example). But I suppose that that was not the intention of the CIRC.

In fact, a health test was applied to a whole team at the same time and mostly to teams staying in the same hotel. This was necessary for logistic reasons. In addition, going from one hotel to the other – even supposing it was possible in view of breakfast time and the start of the race – would also have given time to the teams to inform each other. The CIRC knows, of course, how to do all this much better than the UCI; it just forgot to tell us.

The summary of the CIRC’s reasoning is then found on page 118: the health tests “acted as a cataclyst to spread even further the use of EPO in the peloton, because in essence it condoned the use of EPO to a certain limit. The message was basically that ‘you could dope, but not too much’”.

This was not the message of the UCI, but rather of the cheats who sought to find some justification for their use of EPO by shifting the responsibility for their behaviour to the UCI. These cheats are eagerly embraced by the CIRC, for which all ammunition to bash the pre-Cookson UCI is welcome.

Health tests or no health tests, the use of any quantity of EPO was forbidden. It was not because riders with haematocrit levels up to 49% were not banned under the no-start rule, that it was somehow permissable to use EPO to increase haematocrit levels up to 49% .

If there had been no health tests and no no-start rule, riders could have increased their haematocrit with EPO up to 60 % or more, without risking a no-start.   So, in the reasoning of the CIRC, the absence of a no-start rule would then have condoned the use of EPO without limit. In the reasoning of the CIRC, the message would have been: you can dope as you like. Would the CIRC have preferred this then?   What a nonsense!

And on what basis does the CIRC suggest that more EPO was used after the introduction of the health test than before? How did the CIRC measure that? The CIRC didn’t examine this of course: it is just gratuitous accusations.

On page 139, the CIRC writes that “it is widely acknowledged that the ‘normalisation’ of the riders’ profiles [in the blood passport] is the consequence of a different doping strategy that enables the riders to stay below the ABP-radar”.   So, according to the CIRC, riders can continue to dope without being caught. Will the CIRC say now that the message is: you can dope, but not too much, just stay below the ABP-radar? It is perverse to present the abuse of the system as the aim of the system, but the CIRC does not hesitate to do that.

The same applies on page 36, where the CIRC writes: “One unintended consequence of the 50% haematocrit threshold on all riders, regardless of their natural levels, was that riders with heamatocrit levels naturally in the low-mid 40s could gain an advantage by using EPO up to 50%”.   At least the CIRC speaks here of an unintended consequence and not of a message, or of condoning the use of EPO, as the CIRC does on page 118. But once again, if there was no threshold, the riders could have done the same and more.

Then the CIRC gives a platform to one (just one!) former rider who apparently stated that “the introduction of the 50% haematocrit value was perceived by riders as legalising EPO up to a certain limit. This anonymous rider claimed that, if a rider had not used EPO before, he would certainly have started using it after the rule was introduced in 1997”.

The CIRC reproduces this extraordinary summary of hypocritical bad faith without batting an eyelid. EPO was, and still is, a prohibited substance. If a rider is honest, he or she will not use EPO.   As the introduction of the haematocrit rule didn’t change anything, honest riders would not use EPO as it remained forbidden and they knew that only too well. Why would a rider suddenly start using EPO up to a 50% level in order to stay under the radar, if before he could have use EPO up to a 55% level or higher, as there was no ‘radar’? This absurd “reasoning” is simply an excuse made by cheats.

The CIRC apparently condones these excuses by cheats and, more, provides a justification for their cheating.

This is a very sad conclusion for a sadly abysmal report.

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