Re:
Teddy Boom said:
At
8:15 into Lance's Stages Podcast on this, he says: "I read an article on cycling tips with a doctor from the Irish federation [...] according to this particular doctor an oral ingestion of this salbutamol would be 20,000." I can't find the article, but if that's true..
Still the wrong timing for taking a transfusion, of course. If you back date the transfusion to a more sensible time, you start having trouble with half life calculations. But, if an oral dose is that much more, I think the transfusion theory might be back on.
No, still probably not nearly enough. I would be interested to know, though, if people can actually tolerate doses as high as those urine levels imply, without major deleterious effects. Possibly at that point they've developed some tolerance.
Let's talk about Froome and the lab test. If he takes this test—and he may not—he won’t go into it unprepared, just hoping it works out. He will have several trial runs, in fact, I strongly suspect he’s already had at least one if not more such trials. If the results are not encouraging—and probably they aren’t, or he would have set a date for the official test--he may decide it’s not worth it to take the test officially.
Here’s what he’s up against. The maximum allowed dose is 800 ug/12 hours. The half-life of salbutamol is about 2.5 hours (according to the researcher on that podcast), so after any dose, only about 3% of drug remains after 12 hours. This assumes first-order kinetics throughout, which probably isn’t the case, but clearly, most of the drug is gone. Therefore, to maximize urine levels, Froome should probably just take one 800 ug dose, in as short a time as possible, and provide a urine sample about one hour later, when urine levels peak.
What are the odds that the concentration will be 2000 ng/ml? Here are four studies, involving a total of 95 subjects, in which the subjects inhaled an 800 ug dose, then urine levels of salbutamol were measured later. In the first two studies, the urine was assayed after 60 minutes. In the third study, it was assayed 1.5-4 hours later; in the fourth study, it was apparently assayed after four hours.
https://www.ncbi.nlm.nih.gov/pubmed/18469572
https://www.ncbi.nlm.nih.gov/pubmed/18091010
http://sci-hub.la/10.1097/jsm.0000000000000072
https://www.ncbi.nlm.nih.gov/pubmed/22388343
Only one of the 95 subjects (or maybe two; one of the studies claimed a high value in one graph, but not in several other graphs) exhibited a urine level of > 1000 ng/ml, and just barely. It was well below 1200 ng/ml, which means it would not reach decision level for an AAF. Also, if the sample was corrected for specific gravity, the level dropped to about 660 ng/ml.
So the odds are stacked against Froome, and I would expect that his trial runs will not give him the result he’s looking for. What does he do then? I think the best option is to take the case directly to CAS. This provides several advantages:
1) He can continue to race while the case is pending, and since it will take several months or more for the CAS scenario to play out (it took nearly a year in the Contador case), Froome is free to pursue the Giro/Tour double. He may not be enthusiastically welcomed at those GTs, but legally, at least, he’s allowed to participate. If he takes the lab test, fails it, and is suspended, he can still go to CAS, but at that point the chance for the double is probably irretrievably lost, depending on the length of the suspension. Even if the suspension ended before the Tour or the Giro, he would not be able to prepare for those races properly. Remember, the stakes are incredibly high here. He's not just trying to win another GT. He's trying for the first Giro-TDF double in twenty years; the first time anyone has won four GTs in a row; and joining the list of greats who have won five Tours. There will never be another chance like this.
2) While CAS will certainly want to see a lab test, he has more control over both how it’s carried out and how it’s interpreted. With regard to the former, he can do it practically under any conditions, as long as he specifies them clearly at the hearing. He can run several tests and furnish only the best results, and those results, whatever they are, will not be made public until the final CAS decision is announced. With regard to the latter, the decision is not necessarily binary. Even if he fails to reach the 2000 ng/ml level, he may argue that the level he does reach is consistent with the possibility of a higher level. E.g., several tests at 1500 ng/ml could be used as evidence that 2000 ng/ml is statistically possible, particularly in conjunction with arguments about how levels are affected by urine concentration, which is not taken into account at the initial hearing.
3) Other evidence that would not be considered in the usual anti-doping case will be important at CAS. E.g., Froome can argue that since there is little support for an aerobic effect of salbutamol, there would be no point in taking it, certainly not during a race. He might bring a certificate from a doctor that would qualify him for a TUE, allowing him to compete with any level of salbutamol. While he did not race the Vuelta with a TUE, in the CAS environment, the mere fact that he could have would work in his favor.
4) Even if didn’t win at CAS—and at this point, based on what’s been made public, I would bet he wouldn’t—he might get a more favorable sanction than he would at an initial hearing. At the time of a hypothetical announcement of a CAS award, Froome might have wins at all three GTs at stake. Rather than losing all three, as he probably would if he were to receive a suspension in the next few months, he might retain at least one or two of them.
5) The bottom line, as I see it, is that he has nothing much to lose by going directly to CAS—except the stress of racing under a cloud—and potentially a lot to gain. Only if he’s quite certain that he can pass that lab test does it seem to make much sense to try to win the case right now.
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