Autologous blood transfusion (or How to win a grand tour in 2009)

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Jul 27, 2009
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because they monitor their profiles, and work with it. And if your blood passport profile is already artificially high, you can just keep it that way.
 
Jun 18, 2009
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elapid said:
I asked this a few months ago but only received an obscure BB answer - why can't they use 2-3 DPG levels to detect autologous blood doping? Is it diluted out to near or normal levels when only 10% of blood volume is transfused?
From Wikipedia (yes, I know, not the most reliable source...)

At present there is no accepted method for detecting autologous transfusions (that is, using the athlete’s own RBCs), but research is in progress and the World Anti-Doping Agency (WADA) has promised that a test will eventually be introduced. The test method and its introduction date are to be kept secret in order to avoid tipping off doping athletes. The assay under development may be a measure of 2,3-bisphosphoglycerate (2,3-BPG) levels in an athlete's red blood cells. Because 2,3-BPG is degraded over time, the stored blood used in autologous transfusions will have less 2,3-BPG than fresh blood. A 2,3-BPG concentration lower than normal may therefore be an indication of autologous transfusion.
It would have to be a pretty sensitive test. If a 150 lb cyclist has, say 5 litres of blood in his body, and was transfused with cells equivalent to 1 litre of blood, if the 2,3-BPG level had dropped 50% in the stored blood, the total amount of 2,3-BPG in a blood test would be 90% of the level before the transfusion (correct?).

So the questions are. What is the normal range of this metabolite in people? Does the level change in elite athletes? How quickly does it recover once the blood is transfused?
 
May 13, 2009
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Cobber said:
From Wikipedia (yes, I know, not the most reliable source...)



It would have to be a pretty sensitive test. If a 150 lb cyclist has, say 5 litres of blood in his body, and was transfused with cells equivalent to 1 litre of blood, if the 2,3-BPG level had dropped 50% in the stored blood, the total amount of 2,3-BPG in a blood test would be 90% of the level before the transfusion (correct?).

So the questions are. What is the normal range of this metabolite in people? Does the level change in elite athletes? How quickly does it recover once the blood is transfused?
This is the same issue which would plague a test based on reticulocyte counting. Both 2,3-DPG and number of reticulocytes are fractionally different in stored blood than fresh. Upon transfusion this fractional change is further diluted since 1 pint of transfused blood will mix with maybe 10 pints of blood in the body. This diluted fractional change has then to be gauged against normal variations of the numbers which might come about when riding a GT or for whatever reason. It's a tall order. I think the better way would be to measure the total volume with the CO method.
 
Mar 19, 2009
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I think I can help

Advancedone said:
I raised the issue of the 24-48 hours with Bigboat and he never answered,.
Its better to be at 59% for 8 hours then to be permanently at 52%. The issue is not wanting to sleep with it at 55% & up, and the morning controls. So the top guys are likely training blood off before sleeping and re-infuse in the morning after controls. They only have to jack all the way for the TTT, the TTs, and the key mountain top finishes. Think of it this way, some Extra red cells WILL start working right away but the MAX effect wont be felt for 48 hours. Trauma patients get some improvement right away.

They come in at 50 & up with blood doping NO DOUBT. They physically come to the race with a jacked crit. Their undoped crits are all in the low 40s or even upper 30s due to hard training, apart from a few exeptions. After that they can blood dope to 55% or higher during the race.

IF I WAS RIDING THE TOUR this year...I'd do this because it might give me another 5-10% more FTP power. You could be right though. Many of them might only take 1 transfusion right before the Tour, or two refills along the way.
 
May 13, 2009
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BigBoat said:
Its better to be at 59% for 8 hours then to be permanently at 52%. The issue is not wanting to sleep with it at 55% & up, and the morning controls. So the top guys are likely training blood off before sleeping and re-infuse in the morning after controls. They only have to jack all the way for the TTT, the TTs, and the key mountain top finishes. Think of it this way, some Extra red cells WILL start working right away but the MAX effect wont be felt for 48 hours. Trauma patients get some improvement right away.

They come in at 50 & up with blood doping NO DOUBT. They physically come to the race with a jacked crit. Their undoped crits are all in the low 40s or even upper 30s due to hard training, apart from a few exeptions. After that they can blood dope to 55% or higher during the race.

IF I WAS RIDING THE TOUR this year...I'd do this because it might give me another 5-10% more FTP power. You could be right though. Many of them might only take 1 transfusion right before the Tour, or two refills along the way.
To be fair, if you re-infuse blood which was taken out the evening before, 2-3 DPG levels shouldn't have dropped far and you would get more immediate benefit than from a 3-month old bag. That part does make sense. (I still don't believe that that is what's going on, though)
 
Jul 29, 2009
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Should autologous transfusions be legalised? It would perhaps reduce the risks if things were out in the open and certain standards applied.

I think it is very much in the grey area of what consitutes doping. It is afterall ones own blood. Arguably it is more natural than many of the legal supplements or chemicals. I believe it didn`t use to be illegal. Why did that change?

There are many people on here that know much more about this than I do so I am prepared to be shot down. Please keep it informative though as I would like to know.
 
Jun 29, 2009
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SirLes said:
Should autologous transfusions be legalised? It would perhaps reduce the risks if things were out in the open and certain standards applied.

I think it is very much in the grey area of what consitutes doping. It is afterall ones own blood. Arguably it is more natural than many of the legal supplements or chemicals. I believe it didn`t use to be illegal. Why did that change?

There are many people on here that know much more about this than I do so I am prepared to be shot down. Please keep it informative though as I would like to know.
Well, the trouble is it then becomes about who responds well to the treatment, much like EPO. Just look at the effect of EPO down the years. Guys who respond well to the therapy, like Pantani, get the glory. Others who decide not to jack, or who don't respond well, or who get side effects, end up nowhere. It's the same with autologous boosting. Some guys will win simply because they respond well to it, not because of their efforts in training/out on the road.

To take a stupid example, if one year the whole peleton rides the tour de france clean and then jacked up the next year, you are gonna get quite a few guys who were nowhere the first year finishing high up on GC the next. Simply because of boosting.
 
Jul 28, 2009
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The practicalities of Autologous Blood Transfusion

Perhaps two or three times during a three week tour, the transfusion of autologous blood in volumes of approximately 500ml would suffice. Daily transfusion and donation would expose the rider to an unacceptable risk of infection. Cannulation / venepuncture of a reasonable calibre vessel 40+ times in 3 weeks is impractical, technically demanding and hard to conceal.

Blood is more viscous than crystalloid and in my experience, even under 100mmHg of pressure, takes 10 minutes to infuse through a 14 or 16G cannula. Kohl has revealed the communication pathways and necessary arrangements.

Targeted testing based on the biological passport and recent performance should find those who are naive enough to boost their haematocrit over 0.50. Currently the medical consultants hired by well funded teams will ensure that no rider over steps the mark.

The necessary dosing of androgens, growth factors and T3 during the tour is miniscule and again practically impossible to detect. It is likely the Di luca non-negatives are due to CERA present in the transfused blood, not from CERA used during the Giro. i.e. the CERA used earlier in the year at the time of donation, the same CERA which would elevate 2-3 DPG levels within the harvested blood.

Remember any gains in performance from transfusion are likely to last for weeks. The gains from newer agents are additive and not widely available.
 
Mar 18, 2009
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Cobblestones said:
To be fair, if you re-infuse blood which was taken out the evening before, 2-3 DPG levels shouldn't have dropped far and you would get more immediate benefit than from a 3-month old bag. That part does make sense. (I still don't believe that that is what's going on, though)
What about measuring the citrate anticoagulant (CPDA-1) as evidence of autologous blood doping?
 
Jul 19, 2009
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Cobblestones said:
This is the same issue which would plague a test based on reticulocyte counting. Both 2,3-DPG and number of reticulocytes are fractionally different in stored blood than fresh. Upon transfusion this fractional change is further diluted since 1 pint of transfused blood will mix with maybe 10 pints of blood in the body. This diluted fractional change has then to be gauged against normal variations of the numbers which might come about when riding a GT or for whatever reason. It's a tall order. I think the better way would be to measure the total volume with the CO method.
Data collection for a study examining the efficacy of the CO rebreathing method finished more than 18 months ago. It only took 3 or 4 months to decide upon the EPO test prior to the 2000 Sydney olympics.

So either the UCI are keeping it under wraps or they are worried it will create a scandal and so they are going over the legal implications with a fine tooth comb. It could easily be the former since the equipment required to conduct the testing is not widely available. It may take time for the analyser and glassware required to be manufactured.

One HUGE advantage of the CO method however, is that results are virtually immediate (10min) and it is very cheap to run. You could easily screen all the main GC contenders out of competition, in the week prior to a GT and then target them at specific points throughout the race.
 
Jul 30, 2009
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Wow - great sub forum category thing

Only just come across this but what an amazing and informative and informed forum. Thanks all - particularly the ex-pros speaking out.

I wondered if I was being too cynical about this year's Tour but looking at some of the performances and at some of these threads I think Bordry will catch a few at some unspecified time in the future.

But not Brad eh? please please please.
 
Mar 10, 2009
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mitochondrion said:
The necessary dosing of androgens, growth factors and T3 during the tour is miniscule and again practically impossible to detect. It is likely the Di luca non-negatives are due to CERA present in the transfused blood, not from CERA used during the Giro. i.e. the CERA used earlier in the year at the time of donation, the same CERA which would elevate 2-3 DPG levels within the harvested blood.
Great info, thanks very much!

So is it then reasonable to believe that di Luca's doctor screwed up?

Could the scenario have been as following:

The dr. (Santuccini?) had 'provided him' with CERA earlier as the new wonder medicine - ie last year's Giro, or later during is training sessions - and they harvested blood at that time, to store it in the fridge. However, once the CERA test came out, during last year's TdF, they realized they had to stop using CERA, but 'forgot' about the harvested blood, that contained traces of CERA...

The doctor shoudl have realised that there would be CERA in previously harvested blood, right?

What is the 'shelf life' of frozen blood? And what is that of CERA?

Could it realistically have been harvested before cyclists became aware of the CERA test?
 
Jul 19, 2009
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This forum has certianly sparked my interest in this area. I work with elite athletes so this could be considered "research" for me! Anyway, I was just looking through some literature on autologous blood transfusions and it shows that if you remove 500m of blood it takes about 35 days to normalise blood volume, but it is possible to take out around 450ml once per week for at least 3 weeks and see a normalisation after about 70 days (instead of requiring around 100 days if you took them out once per month).

What this tells us is that during the off-season blood is coming out, most likely at the rate of 500m per week for a month or so, and then a range of methods eg: CERA, EPO, hematide, steroids could be employed to bring the levels back to normal far more rapidly than the above. Cease using these products for about 3 weeks and then repeat the process. In the space of 4 months you could have 2-3 L of your own blood ready at hand. Accelerated erythropoesis will show up in the blood tests alone due to the natural homeostatic regulation that occurs in response to the blood loss.

Its no secret that every year Lance would disappear for months at a time in the off-season on "training" camps conducted in remote locations, where he was unavailable for out of competition testing.

If you conduct CO rebreathing + blood testing during that period, and again at the onset of a GT and 2 or 3 times during a GT, you WILL catch them out.

The problem IMO is not 100% technical. If the UCI wants to catch these cheaters they can do it. All it takes is the political will to do so. Ramp up the random out of competition testing and ENFORCE bans if they fail to show up. Rasmsussen failed to show for 4yrs in a row before they finally pulled him. Its a farce.
 
Jul 16, 2009
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blackcat said:
its cheating, its doping, and it can be dangerous. You should do some homework before a silly post like that.

Did PDM get dodgy blood way back? Not sure. But in 2004 Vuelta, Vino and the T-Mobile riders all pulled out of the Vuelta with "sickness", a food poisoning. Yeah, sure. The story is it was bad blood transfusions. Evans, Konecny and Zabel whom did not suffer the "food poisoning" stayed in the race. No dodgy transfusions, as they did not get blood.

Could be apocryphal. Me: leaning to 50/50. As there is a lotta BS, but lots of truth and substance in the doping tales. Put about twice as much stock in this tho, than the function you assess Bigboat with.

Blackcat thank you for taking the time to reply to my post.

Perhaps a little less aggression in the post might have been appreciated- I offer that I am not an expert and learning, hence why I am here.

Can I perhaps restate the question I asked- “amongst_the cyclists_,is ABT regarded as cheating (not is it dangerous, does it have consequences or is it breaking “rules”)

If you ask me hanging onto the team car while getting a drink and taking that last shove they all take from the manager is cheating, and it is also against rules as I understand, but people bear it

Same with drafting automobiles. It is cheating and against the “rules” but looked the other way if a rider say had a fall and is catching up to a peleton and only does it a bit

The answer may be_explicity_YES!!!! but from what I am reading here it is completely part and parcel of the tour.

Here is what I am asking

Climbers have to climb a hill with a mandatory 5kg backpack

They all stop in the tunnel and throw 3kg off the side of the hill, then ride on.

If it appears they are ALL doing it, do the contention cyclists regard that they are cheating_each other_by taking this action?
 
Jul 19, 2009
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Ozzie2, I have been involved with elite sport for many yrs now and the debate about whether or not to let sport be a free for all versus maintaining bans on drugs and doping methods has always existed.

It is a philosophical and ethical debate. The way that I view it is that human performance is a combination of two main factors, genetics and environment. The interaction between those two factors underlies important charateristics such as the psychology of elite performance, ie: determination, motivation etc. It also underlies the physiology of elite performance, the right genetics are required to produce a world champion, but genetics on their own will not suffice. This is where training and nutrition become important. Now lets add a very important co-variable into this equation.... MONEY. Countries with more money are more successful at sport in general. On this topic I don't think you can use the argument that simply having more money is unethical (you can) but it opens a whole new can of worms. Regardless of how much money you have though (to spend on cutting edge sports science and technology for example) this on its own does not produce a world class athlete. You must have the first 2 factors which are far more important than money.

BUT, PEDs and doping methods bring a different kind of variable into the equation. Now you are able to bypass the first 2 factors and create something that is unphysiological. IMO it brings a fundamental change to the world of sports performance. Our ethical and moral code dictates that we humans want to compete against each other using human evolution as our benchmark. Once we start playing around and artifically manipulating our evolutionary history we are changing that benchmark. we create performances that may not be possible to achieve with genetics and environment alone.

Humans in general are honest creatures IMO. We want to see the gladiators fight it out based on their skills and strength. If a doctor behind the scenes becomes just as resposnsible as the athlete we are always left wondering who the real winner was, the athlete, the doctor or some combination of both? Think about that weird empty feeling you get when you see a movie that finishes without an ending, or how people feel whose loved ones go missing never to be found. I think humans need closure. If drugs were legal, I believe we loose that closure.
 
Jul 19, 2009
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Another way to explain this is by using the example of tension and resolve. The musicians in the audience know what this means ;)

Applied to sports what it means is that tension is created during the contest. There is a level of suspense which creates an emotional state (of tension). When the final whistle is blown, there is an outcome and the tension is resolved. Everyone breathes a sigh of relief because the emotional state has been removed, even if that means your team or guy/girl lost. You might be annoyed, but at least you know what the result was.

If you allow a free for all drugs situation, the tension remains because you just don't know whether or not the outcome is based on genetics and environment or whether if was influenced by something that is out of control of the competitor themselves.
 
Jun 22, 2009
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mitochondrion said:
Perhaps two or three times during a three week tour, the transfusion of autologous blood in volumes of approximately 500ml would suffice. Daily transfusion and donation would expose the rider to an unacceptable risk of infection. Cannulation / venepuncture of a reasonable calibre vessel 40+ times in 3 weeks is impractical, technically demanding and hard to conceal.
+1 very close to how i picture it, we might be exploding some myths now


Krebs cycle said:
Applied to sports what it means is that tension is created during the contest. There is a level of suspense which creates an emotional state (of tension). When the final whistle is blown, there is an outcome and the tension is resolved. Everyone breathes a sigh of relief because the emotional state has been removed, even if that means your team or guy/girl lost. You might be annoyed, but at least you know what the result was.

If you allow a free for all drugs situation, the tension remains because you just don't know whether or not the outcome is based on genetics and environment or whether if was influenced by something that is out of control of the competitor themselves.
krebs is sounding like a polymath here. exercise science AND an appreciation for classical music. i love it. tension and release (as i learned it) is a nice analalogy but i think its deeper than that. we are always comparing sport to life. we say cycling or "fill in the blank" is the sport most like life. this is fallacy. we really wish life were like sport. everyone starts with a blank slate, an even playing field, and clearly defined rules are the definition of a meritocracy. it is where effort overcomes disadvantage. it is a comfort in an otherwise unfair world. when sport becomes unfair we are left with emptiness where we seek comfort. athletics should be an an escape to or an example of a better place, not another reminder of injustice. this philosophical debate is VERY deserving of its own thread.
 
Great posts Krebs, one small correction though. Rasmussen failed to show for four tests. You said "4yrs in a row". Just don't want others to get confused.

Ozzie2 said:
Can I perhaps restate the question I asked- “amongst_the cyclists_,is ABT regarded as cheating (not is it dangerous, does it have consequences or is it breaking “rules”)

If you ask me hanging onto the team car while getting a drink and taking that last shove they all take from the manager is cheating, and it is also against rules as I understand, but people bear it?
Some things to consider. First, it isn't natural in any way to re-infuse your own blood, other than to combat illness (such as cancer recovery). It does however give you a solid advantage for aerobic endurance. Thus, it is cheating.

Next, no one ever has gained a huge advantage by using sticky bottles to help climb hills. There are a few cases where people squawked about it. In the 1986 Tour, Sean Kelly almost got into a fist fight with Erik Vanderarden because while Sean had climbed all the mountains that year (a tough year too), Erik had rode up the hills on long stretches with both the help of car handles, and pushes from fans. But they were competing for the Maillot Vert. Not the overall victory. If Erik had done that in an attempt to win the Maillot Jaune, I'm sure quite a few riders would have joined in on the fist fight.

In the 2006 Tour, during Floyd Landis breakaway he used something like 85 water bottles, pouring most over his head. Several of those were sticky bottles. But most were not. The issue only came up through some speculation in the press. None of his rivals, and no serious fans thought Floyd had used that to an advantage. Did Floyd cheat? Not by using sticky bottles. He did cheat by doping. But he was also in the majority there, as it's highly likely many others were doping too. But there's also a rub. Just who was doping how much? One might say that Floyd was getting superior doping to that of his rivals, and thus cheated more. Just as Bjarne Riis probably doped more than Indurain, Rominger, Zulle, etc. during the 1996 Tour.

Again, great thread. I'm learning a lot here.
 
Mar 10, 2009
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sorry for asking yet another stupid question. What are sticky bottles ? Not heard that used before so must have missed it.

I do wonder with a lot of the cyclists being intelligent people and with the start of EPO with them having to wake up in the night to walk around and all the other risks and with a few dying in their sleep why didn't the whole peleton just turn round and say no and speak out about it
 
Jul 25, 2009
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sherer said:
sorry for asking yet another stupid question. What are sticky bottles ? Not heard that used before so must have missed it.

I do wonder with a lot of the cyclists being intelligent people and with the start of EPO with them having to wake up in the night to walk around and all the other risks and with a few dying in their sleep why didn't the whole peleton just turn round and say no and speak out about it
Because it worked and from what we know, the enhancement was substantial.
It is likely some riders did not accept it, retired or stopped pro cycling. Isn't that what LeMond says? That he stopped because he was just trailing 30mn away in the nineties?
 
Jun 29, 2009
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sherer said:
sorry for asking yet another stupid question. What are sticky bottles ? Not heard that used before so must have missed it.

I do wonder with a lot of the cyclists being intelligent people and with the start of EPO with them having to wake up in the night to walk around and all the other risks and with a few dying in their sleep why didn't the whole peleton just turn round and say no and speak out about it
In the early days EPO use was a serious game of russian roulette. Once the correct anticoagulant/antiplatelet treatment was figured out (probably aspirin) the risks were reduced, although not eliminated. If the risks of dying are 1/100, more guys are gonna be tempted than if they're 1/10, especially if you're desperate for success.
 
Jul 16, 2009
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Krebs cycle said:
Ozzie2, I have been involved with elite sport for many yrs now and the debate about whether or not to let sport be a free for all versus maintaining bans on drugs and doping methods has always existed.

It is a philosophical and ethical debate. The way that I view it is that human performance is a combination of two main factors, genetics and environment. The interaction between those two factors underlies important charateristics such as the psychology of elite performance, ie: determination, motivation etc. It also underlies the physiology of elite performance, the right genetics are required to produce a world champion, but genetics on their own will not suffice. This is where training and nutrition become important. Now lets add a very important co-variable into this equation.... MONEY. Countries with more money are more successful at sport in general. On this topic I don't think you can use the argument that simply having more money is unethical (you can) but it opens a whole new can of worms. Regardless of how much money you have though (to spend on cutting edge sports science and technology for example) this on its own does not produce a world class athlete. You must have the first 2 factors which are far more important than money.

BUT, PEDs and doping methods bring a different kind of variable into the equation. Now you are able to bypass the first 2 factors and create something that is unphysiological. IMO it brings a fundamental change to the world of sports performance. Our ethical and moral code dictates that we humans want to compete against each other using human evolution as our benchmark. Once we start playing around and artifically manipulating our evolutionary history we are changing that benchmark. we create performances that may not be possible to achieve with genetics and environment alone.

Humans in general are honest creatures IMO. We want to see the gladiators fight it out based on their skills and strength. If a doctor behind the scenes becomes just as resposnsible as the athlete we are always left wondering who the real winner was, the athlete, the doctor or some combination of both? Think about that weird empty feeling you get when you see a movie that finishes without an ending, or how people feel whose loved ones go missing never to be found. I think humans need closure. If drugs were legal, I believe we loose that closure.

that was a very insightful post.

thank you, i enjioyed reading that
 
Jul 27, 2009
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sherer said:
sorry for asking yet another stupid question. What are sticky bottles ? Not heard that used before so must have missed it.
Sticky bottles are when you're getting a new water bottle from the team car and hold onto just that bit longer in order to get a bit of a tow, then a push off against a firm arm just as the car has mysteriously accelerated.
 
Jul 16, 2009
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sherer said:
sorry for asking yet another stupid question. What are sticky bottles ? Not heard that used before so must have missed it.

I do wonder with a lot of the cyclists being intelligent people and with the start of EPO with them having to wake up in the night to walk around and all the other risks and with a few dying in their sleep why didn't the whole peleton just turn round and say no and speak out about it

sticky bottles- they grab a drink from someone in the car and hold the bottle for 3-4 seconds and get a nice ol shove forwards by the car

yes intelligent, not all of course

pressure. jobs, mortgage, wives, kids, lifestyle, peer pressure, done thing.

i take risks every day just driving to work

know anyone who smokes?

drinks alcohol? coffee?

as for speaking out, did it do a sit in a few years ago before a TdF stage re how much blood doping they could do? can't remember much but vaguely remember something? (anyone fill in teh gaps)
 

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