General Doping Thread.

[E_F_]

This one right? https://pubmed.ncbi.nlm.nih.gov/32118696/

Looks like a small sample to base conclusions on. But maybe?

A New Method to Improve Running Economy and Maximal Aerobic Power in Athletes: Endurance Training With Periodic Carbon Monoxide Inhalation - PMC

Altitude training stimulates erythropoietin hormone (EPO) release and increases blood hemoglobin (Hb) mass, which may result in improved oxygen (O2) transport capacity. It was hypothesized in the present study that periodic inhalation of carbon ...

www.ncbi.nlm.nih.gov

Carbon Monoxide: A New Edge in Endurance Performance?

Discover how controlled carbon monoxide inhalation boosts endurance performance, rivaling altitude training and raising ethical questions in sports medicine.

www.innovations-report.com

The effect of carbon monoxide inhalation on exercise-induced adaptation in endurance athletes | Gymnastik- och idrottshögskolan

www.gih.se

I mean, seems like a decent evidence basis within 2 minutes of searching.

Here is the comment, I was thinking of.

"Acutely, EPO increased sharply post CO inhalation, peaking at 4 h post inhalation. 4-weeks of training with CO inhalation before exercise sessions improved tHb and VO2max as well as running economy, suggesting that moderate CO inhalation could be a new method to improve the endurance performance in athletes."

So huffing a bit of CO right before getting to the start line should give you an absolutely massive advantage... Of course you post race test values might be too ridiculous, but I'm sure the teams would know how to manage that. They use carbon monoxide rebreathing for testing hematocrit after all.

 

[Monoxidator]

Here is the comment, I was thinking of.

"Acutely, EPO increased sharply post CO inhalation, peaking at 4 h post inhalation. 4-weeks of training with CO inhalation before exercise sessions improved tHb and VO2max as well as running economy, suggesting that moderate CO inhalation could be a new method to improve the endurance performance in athletes."

So huffing a bit of CO right before getting to the start line should give you an absolutely massive advantage... Of course you post race test values might be too ridiculous, but I'm sure the teams would know how to manage that. They use carbon monoxide rebreathing for testing hematocrit after all.

If you read the report on the Bahrain signing, it's pretty clear that the Bio Passport levels are more of a "guideline" which has values that if you exceed them you need an "explanation" for. AKA "altitude training." It's so absurd, I'm not sure why they even bother with the passport.

 

[Nomad]

Okay, now that the UCI decided to publish some creative fiction in CyclingNews, I feel compelled to respond. I was one of the scientists on Stannard's defense team, so I can tell you more about the charges and lack of evidence that went into the decision. There is a good reasona why Bahrain looked at the data and concluded there was no evidence of doping; any competent scientist would come to the same conclusion. There will be a lot more coming out, but here is what happened.

Stannard was penalized for sample 2 (Hb and OFF) and sample 6 (reticulocyte% and OFF). What they don't tell you is that sample 2 was taken after 5 weeks of altitude training, and sample 6 was within both the biological passport limits and the normal population range. When adjusted for either age or altitude exposure, sample 2 was within the biological passport limits. No justification was given for overriding the passport on sample 6.

The "expert" panel (3 mediocre at best scientists) used some very creative statistics. They agreed that both age and altitude exposure would increase Hb and OFF, and if correct statistical procedures were used with the adjustments suggested by the panel, there was no positive test. The experts on the other hand, decided not to include any variability in their analysis, which meant that any sample would be deemed positive. The only justification for sample 6 being positive was that if an inconvenient data point were removed, the OFF score for sample 6 would be positive. But that isn't allowed.

We asked on multiple occasions for an independent review of the arguments, but the expert panel declined. For the tribunal, the judge selected and paid by the UCI decided no independent review was need because the expert panel would decide: in effect they were prosecution and jury. It was a kangaroo court.

Also note: 1) the WADA and UCI regulations specify that a case must be brought within seven days. This was ignored. 2) if procedures were followed, this expert panel would not have been the first to review the data. There would have been at least two others that looked at the same data and decided there was no proof of doping. The UCI claims to not keep records of previous analyses (if you have ever worked at a lab, you would be skeptical of that) and refused to release the results of the urine tests taken at the same time.
3) The biological passport is junk science. The current algorithm is hidden from the public and not made available to the defense. In fact, the expert panel didn't even know what was in the algorithm. The original paper was published in 2006, but after it was questioned in academic journals it was hidden, but it is apparent that something similar is used with lower variability. In any case, the UCI does not allow the biological passport to be questioned at the tribunal.

In the end, the tribunal made a very cynical decision in backdating the ban. If the ban had started when the procedures started, Stannard would have his career over and would have no reason not to go to CAS. But, because he was immediately eligible, he had to choose between appealing to CAS and being suspended until a decision was reached (probably in several years) or to resume his career.

I think it is fair to say that the current version of anti-doping is a joke. At some point it will go to a real court, and the UCI and WADA will lose badly.

"The "expert" panel (3 mediocre at best scientists)?" Are you kidding? The three experts on the panel: 1) Dr Jakob Morkenberg 2) Dr Laura Lewis 3) Dr Paulo Paixao.

Lewis & Morkenberg are on the board of WADA's Hematological Athlete Biological Passport Working Group which is chaired by renowned anti-expert Olaf Schumacher. The board provides expert advice, recommendations & guidance with regards to the hematological module of the ABP:

Haematological Athlete Biological Passport Working Group

A WADA Working Group

www.wada-ama.org

Furthermore, Morkenberg & Paixao have expertise in clinical hematology & Lewis expertise with hypoxia's effect on the hematological parameters of the ABP. All three have served as anti-doping experts at many Tribunal hearings as well as testified at many CAS hearings, some involving high-profile cases from athletics.

The anti-doping experts noted sample #2 (OFF-score: 123.1) was taken at the start of the Tour de l'Avenir & sample #6 (OFF-score: 122.01) was taken one week after the national championships. These by far were the two highest OFF-scores on the profile, both meeting the 99% specificity.

All of your points & challenges were addressed by the anti-doping experts citing case studies throughout the hearing. I'm not going to go over each one here - people can read the hearing in it's entirety. I will note that under paragraph #35, the anti-doping experts unanimously concluded that none of your arguments "provided any credible explanation for the abnormalities observed on the profile."

Additionally, the Judge in the case concluded in paragraph #230 that based on the evidence presented, she was "comfortably satisfied that the rider committed an ADRV."

Btw, the ABP has been challenged numerous times over the years in CAS hearings. Paragraph #200 cites & summarizes some of those challenges - concluding that the ABP is "a reliable means of evidence for the purpose of establishing the use of a prohibited substance or method."

The ABP (hematological module) has been in use since 2009. There are over 180 ADRVs as a result of hematological anomalies. A high percentage of these cases come from athletics with Russia leading the world in ABP hematological anomalies bans with over 70! It's the only reliable method to detect blood transfusions & the off-phase of use of an ESA where the doper avoids testing positive but has hematological anomalies still present.

Remember when the test for rEPO was developed in 2000, there was a dramatic shift to blood transfusions IC (see Lance Armstrong's systematic doping regime with US Postal during the Tour). Until the ABP was developed, there was no way of detecting blood transfusions. The UCI utilized the 50% Hct upper-limit rule which only resulted in a two (2) week no-competition down time period. And this rule certainly didn't do much for the athletes that had low baseline Hct levels that could dope right up to the limit & have a significant advantage in competition.

One of Schumacher's excellent papers on the basic fundamentals of the hematological module of the ABP covering both transfusions & ESA use:

Detection of EPO doping and blood doping: the haematological module of the Athlete Biological Passport - PubMed

The increase of the body's capacity to transport oxygen is a prime target for doping athletes in all endurance sports. For this pupose, blood transfusions or erythropoiesis stimulating agents (ESA), such as erythropoietin, NESP, and CERA are used. As direct detection of such manipulations is...

pubmed.ncbi.nlm.nih.gov

The PDF on the Tribunal hearing:

https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://assets.ctfassets.net/761l7gh5x5an/3NIby352rhLqCoEhjeEySj/0882e917c8ab7cf9d3dc3a9e77aa350c/Judgment_UCI_ADT_05.2023_UCI_v._Mr_Robert_Stannard_publication.pdf&ved=2ahUKEwj3hfCBn5GIAxVFDjQIHVfXBxsQFnoECB8QAQ&usg=AOvVaw28CFlOZ1nIAnh8SZNroHk2

 

[Sciatic]

"The "expert" panel (3 mediocre at best scientists)?" Are you kidding? The three experts on the panel: 1) Dr Jakob Morkenberg 2) Dr Laura Lewis 3) Dr Paulo Paixao.

Lewis & Morkenberg are on the board of WADA's Hematological Athlete Biological Passport Working Group which is chaired by renowned anti-expert Olaf Schumacher. The board provides expert advice, recommendations & guidance with regards to the hematological module of the ABP:

Haematological Athlete Biological Passport Working Group

A WADA Working Group

www.wada-ama.org

Furthermore, Morkenberg & Paixao have expertise in clinical hematology & Lewis expertise with hypoxia's effect on the hematological parameters of the ABP. All three have served as anti-doping experts at many Tribunal hearings as well as testified at many CAS hearings, some involving high-profile cases from athletics.

The anti-doping experts noted sample #2 (OFF-score: 123.1) was taken at the start of the Tour de l'Avenir & sample #6 (OFF-score: 122.01) was taken one week after the national championships. These by far were the two highest OFF-scores on the profile, both meeting the 99% specificity.

All of your points & challenges were addressed by the anti-doping experts citing case studies throughout the hearing. I'm not going to go over each one here - people can read the hearing in it's entirety. I will note that under paragraph #35, the anti-doping experts unanimously concluded that none of your arguments "provided any credible explanation for the abnormalities observed on the profile."

Additionally, the Judge in the case concluded in paragraph #230 that based on the evidence presented, she was "comfortable satisfied that the rider committed an ADRV."

Btw, the ABP has been challenged numerous times over the years in CAS hearings. Paragraph #200 cites & summarizes some of those challenges - concluding that the ABP is "a reliable means of evidence for the purpose of establishing the use of a prohibited substance or method."

The ABP (hematological module) has been in use since 2009. There are over 180 ADRVs as a result of hematological anomalies. A high percentage of these cases come from athletics with Russia leading the world in ABP hematological anomalies bans with over 70! It's the only reliable method to detect blood transfusions & the off-phase of use of an ESA where the doper avoids testing positive but has hematological anomalies still present.

Remember when the test for rEPO was developed in 2000, there was a dramatic shift to blood transfusions IC (see Lance Armstrong's systematic doping regime with US Postal during the Tour). Until the ABP was developed, there was no way of detecting blood transfusions. The UCI utilized the 50% Hct upper-limit rule which only resulted in a two (2) week no-competition down time period. And this rule certainly didn't do much for the athletes that had low baseline Hct levels that could dope right up to the limit & have a significant advantage in competition.

One of Schumacher's excellent papers on the basic fundamentals of the hematological module of the ABP covering both transfusions & ESA use:

Detection of EPO doping and blood doping: the haematological module of the Athlete Biological Passport - PubMed

The increase of the body's capacity to transport oxygen is a prime target for doping athletes in all endurance sports. For this pupose, blood transfusions or erythropoiesis stimulating agents (ESA), such as erythropoietin, NESP, and CERA are used. As direct detection of such manipulations is...

pubmed.ncbi.nlm.nih.gov

The PDF on the Tribunal hearing:

https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://assets.ctfassets.net/761l7gh5x5an/3NIby352rhLqCoEhjeEySj/0882e917c8ab7cf9d3dc3a9e77aa350c/Judgment_UCI_ADT_05.2023_UCI_v._Mr_Robert_Stannard_publication.pdf&ved=2ahUKEwj3hfCBn5GIAxVFDjQIHVfXBxsQFnoECB8QAQ&usg=AOvVaw28CFlOZ1nIAnh8SZNroHk2

Excellent info. Thanks.

 

[Nomad]

Appreciate it...thanks

 

[Nick2413]

Here is the comment, I was thinking of.

"Acutely, EPO increased sharply post CO inhalation, peaking at 4 h post inhalation. 4-weeks of training with CO inhalation before exercise sessions improved tHb and VO2max as well as running economy, suggesting that moderate CO inhalation could be a new method to improve the endurance performance in athletes."

So huffing a bit of CO right before getting to the start line should give you an absolutely massive advantage...

Sounds like EPO itself would be increased while under the effects of the CO but the increase in RBC/HGB would still come later or at least be hindered until the CO leaves the system, which is supposedly 4-8 hours. I wonder if they can detect abnormal levels in non-synthetic EPO or only the synthetic kind.

 

[yaco]

What I meant was WADA either has no test for the latest rocket fuel or is turning a blind eye to it's use.

It's a bit more nuanced than this. It can take years to determine that a substance can have performance enhancing properties and what percentage is performance enhancing that would meet the WADA Anti-Doping code. At the end of the day if a professional athlete was advised that eating cow poo was performance enhancing then athletes would use it. I've always thought there is not enough distinction between legal and illegal doping in discussions.

 

[SHAD0W93]

It's a bit more nuanced than this. It can take years to determine that a substance can have performance enhancing properties and what percentage is performance enhancing that would meet the WADA Anti-Doping code. At the end of the day if a professional athlete was advised that eating cow poo was performance enhancing then athletes would use it. I've always thought there is not enough distinction begin legal and illegal doping in discussions.

Exactly, a sport the athlete will try as many ways as possible to get an advantage legally when the opportunity presents itself. It’s like fans getting mad at players for attempting to get flags in football, yet free yards or downs are free and a benefit.

 

[E_F_]

Sounds like EPO itself would be increased while under the effects of the CO but the increase in RBC/HGB would still come later or at least be hindered until the CO leaves the system, which is supposedly 4-8 hours. I wonder if they can detect abnormal levels in non-synthetic EPO or only the synthetic kind.

Ah. Thank you for pointing that out. I forgot about EPO being the catalyst for red blood cell production rather than useful in itself. Surely the massive boost in EPO would result in a later boost in hematocrit, or perhaps not?

 

[peterfin]

If you read the report on the Bahrain signing, it's pretty clear that the Bio Passport levels are more of a "guideline" which has values that if you exceed them you need an "explanation" for. AKA "altitude training." It's so absurd, I'm not sure why they even bother with the passport.

I wonder if there is a recent pattern between the weeks of altitude training of the teams vs their relative performance. In the past, the moto was the more highaltitude training, the better. However, altitude training has little value if you can manipulate your blood. On the contrary, training at altitude limits peak power training as the body can't be put to the same strain as closer to sea level. So teams using other "methods" to change blood values may limited it to about 3 weeks of training prior to a GT just for the "explanation".

 

[Pozzovivo]

Here is the comment, I was thinking of.

"Acutely, EPO increased sharply post CO inhalation, peaking at 4 h post inhalation. 4-weeks of training with CO inhalation before exercise sessions improved tHb and VO2max as well as running economy, suggesting that moderate CO inhalation could be a new method to improve the endurance performance in athletes."

So huffing a bit of CO right before getting to the start line should give you an absolutely massive advantage... Of course you post race test values might be too ridiculous, but I'm sure the teams would know how to manage that. They use carbon monoxide rebreathing for testing hematocrit after all.

Thank you for sharing. The first article refers to the same that I cited. The second is the weakest research i've read in a while - and this is my job btw. Very typical of sports science. Tiny sample sizes (5 soccer players - they need to do learn statistics again), no preregistration of hypotheses, no data availability, no data analysis scipt, and not even accurately reporting the results. P >.05 is not how you report p values in modern day science. You need to report the actual p-value because they can easily be misleading. And you absolutely have to report confidence intervals in this type of research. We have absolutely no basis to know how the results look against normal and random fluctuation in the parameters given the variation betwen people. Thus, we cannot know if the difference between before and after treatment fits normal fluctuations in the parameters or if they are very unlikely which suggest that the method has a real effect. They also write the paper as if the methods support huge increases in blood value but read the results:

They even state that in the results section of the paper: there were no differences between pretest and posttest in RBC, Hct, Hb, and MCV. The RBC, Hct, HGB, MCV, and ES are red blood cells, hematocrit, hemoglobin, mean corpuscular volume, and effect size, respectively.

Let me be clear - this method may work but this research is nothing more than suggestive. They are probably showing random flutuations on blood and oxygen parameters. While they claim to find large effects (3-5%) the research based on a sample of 5(!) does not actually back it up.

 

[Pozzovivo]

Ah. Thank you for pointing that out. I forgot about EPO being the catalyst for red blood cell production rather than useful in itself. Surely the massive boost in EPO would result in a later boost in hematocrit, or perhaps not?

Yes, under almost all normal circumstances increased levels of EPO should result in higher hematocrit levels with time.

 

[Rob5091]

As we're talking EPO, is there any news on the WADA problems with their EPO testing?

 

[E_F_]

Let me be clear - this method may work but this research is nothing more than suggestive. They are probably showing random flutuations on blood and oxygen parameters. While they claim to find large effects (3-5%) the research based on a sample of 5(!) does not actually back it up.

Damn. I guess we won't know the effect it has in a while. I have too much trust in papers - just reading the conclusions...

 

[Pozzovivo]

Damn. I guess we won't know the effect it has in a while. I have too much trust in papers - just reading the conclusions...

What we need is a study with more transparent research practices and greater statistical power, which usually comes from a larger sample size. It's possible that studies like this have already been conducted but remain unpublished by teams like Jumbo and UAE. I believe there's a chance they've investigated this. The initial data is suggestive of an effect. Also, I heard one of the worlds leading expert (Nicolai Nordsborg) say that he feared this was going to be used if not used already.

Looking into this, and I am more concerned than ever. It would be disappointing to learn if this stuff was behind TP and JV performances this year and JV performances last year.

The intense inhalation protocol suggests that you should not be racing too much. Who takes long breaks from racing and then show up flying?

 

[E_F_]

The intense inhalation protocol suggests that you should not be racing too much. Who takes long breaks from racing and then show up flying?

Damn. That would explain the reductions in race days we are seeing.

 

[Pozzovivo]

Damn. That would explain the reductions in race days we are seeing.

Maybe, it could be one of the reasons i would say.

It is however also common sense that you can't be racing 90 days a year and perform at peak level throughout compared to people who have more targeted prep. Most other endurance sports have like 10-20 competition days a year. Cycling is a real outlier and peak performance is far more difficult in cycling for normal riders who can't tailor a whole season to their main objective like GC leaders.

 

[E_F_]

Also, I heard one of the worlds leading expert (Nicolai Nordsborg) say that he feared this was going to be used if not used already.

I would love to look into it, if you had a link! (For some reason Danes are over respresented in doping science..!)

 

[Pozzovivo]

I would love to look into it, if you had a link! (For some reason Danes are over respresented in doping science..!)

I need to correct myself: it was the danish altitude expert Lars Nybo - not Nicolai Nordsborg.

Nordborgs once claimed altitude was mostly placebo. - Maybe he still claims that? Mixed the names up.


It was discussed in this podcast: Forhjulslir - the danish podcast.

View: https://open.spotify.com/episode/0hP3OnZphU1II7vOxidUzB
The episode was the tour de france recap. It's in danish language btw.
Here:
At 37 minutes into the program, we call Lars Nybo, a professor of Movement and Neuroscience at the University of Copenhagen. It's no secret that Pogacar and Vingegaard have broken one record after another in the Tour's mountain stages. So, we ask Nybo for his scientific perspective on these performances, which leads to an extremely interesting and informative discussion.

 

[Sciatic]

Here is the comment, I was thinking of.

"Acutely, EPO increased sharply post CO inhalation, peaking at 4 h post inhalation. 4-weeks of training with CO inhalation before exercise sessions improved tHb and VO2max as well as running economy, suggesting that moderate CO inhalation could be a new method to improve the endurance performance in athletes."

So huffing a bit of CO right before getting to the start line should give you an absolutely massive advantage... Of course you post race test values might be too ridiculous, but I'm sure the teams would know how to manage that. They use carbon monoxide rebreathing for testing hematocrit after all.

If it dramatically increases HCT it should set off some biopassport alarms, no ? Aside from WADA, I wonder where this method would fit under criminal anti-doping laws in countries like France and Germany? Or in Suisse, where some doping prosecutions have been based on fraud? Not making conclusions, just curious.

Also, if the increases in HCT are due to a hypoxia effect like in altitude training, the increased HCT will gradually degrade and be gone by 1 1/2 or 2 weeks. So for GTs that means having to bring equipment along or arrange to have it set up at rest day locations. Which wouldn’t seem too difficult.
And my 2cents (do you folks use a similar phrase in your language?) is that while that research is intriguing there’s no way a study that small or even several studies of that size are enough to make firm conclusions from. There are thousands (no exaggeration) of robust research studies on EPO effects so it easier to draw conclusions about that.

 

[Sciatic]

Thank you for sharing. The first article refers to the same that I cited. The second is the weakest research i've read in a while - and this is my job btw. Very typical of sports science. Tiny sample sizes (5 soccer players - they need to do learn statistics again), no preregistration of hypotheses, no data availability, no data analysis scipt, and not even accurately reporting the results. P >.05 is not how you report p values in modern day science. You need to report the actual p-value because they can easily be misleading. And you absolutely have to report confidence intervals in this type of research. We have absolutely no basis to know how the results look against normal and random fluctuation in the parameters given the variation betwen people. Thus, we cannot know if the difference between before and after treatment fits normal fluctuations in the parameters or if they are very unlikely which suggest that the method has a real effect. They also write the paper as if the methods support huge increases in blood value but read the results:

They even state that in the results section of the paper: there were no differences between pretest and posttest in RBC, Hct, Hb, and MCV. The RBC, Hct, HGB, MCV, and ES are red blood cells, hematocrit, hemoglobin, mean corpuscular volume, and effect size, respectively.

Let me be clear - this method may work but this research is nothing more than suggestive. They are probably showing random flutuations on blood and oxygen parameters. While they claim to find large effects (3-5%) the research based on a sample of 5(!) does not actually back it up.

Great info. I also noticed that the quote from one of the articles claimed the method increases erythropoietin levels after use. But increasing natural EPO levels only spurs new blood cell production that takes, what, about 48 hrs to happen and then longer to increase the number of circulating RBCs in the bloodstream, so this isn’t something riders could used for a quick boost before a race—it would have to be systematic use for a period before a race, as with altitude training.

Either that or the others confused EPO levels with HCT numbers, which would be pretty damning.

ed. Sorry, didn’t notice Nick already explained about the EPO boost.

 

[E_F_]

If it dramatically increases HCT it should set off some biopassport alarms, no ?

It should for sure, but I believe they just point to being at altitude camp or in that one altitude hotel or even just sleeping in an altitude tent - and then that's that.

 

[E_F_]

it would have to be systematic use for a period before a race, as with altitude training.

The difference being that the systematic use could continue throughout the race.

 

[Sciatic]

It should for sure, but I believe they just point to being at altitude camp or in that one altitude hotel or even just sleeping in an altitude tent - and then that's that.

Of course, but that would mean the HCT boost seen in the research would not be the level a rider would start a race with, because the HCT boost from altitudes degrades at a fairly steady and recognizable rate upon return to lower elevation.

 

[E_F_]

Of course, but that would mean the HCT boost seen in the research would not be the level a rider would start a race with, because the HCT boost from altitudes degrades at a fairly steady and recognizable rate upon return to lower elevation.

Absolutely, but I think the burden of proof in anti-doping is sky high, to the point that I believe they look past thousands of test results that I would be happy to assume guilt based on.