Understanding the Biological Passport

[elapid]

You seriously missed the point. It was not an argument against the existence of blood doping: it was an argument against a bunch of laymen on the internet being able to look at some numbers and declare who has or hasn't been doping.

The suggestion is that we can all read one article, understand the biological passport, look at some numbers, and declare who has been blood doping or using epo. I don't believe it will be so easy. Is a change in hemoglobin due to doping or hydration level or prolonged exertion or legal training methods or illness or disease or just-the-way-that-person's-body-functions?

To suggest that cycling fans (that aren't hemotologists or hemopathologists) are qualified to make that determination is just silly to me.

As for my personal tests - it isn't just that 2% were out of line. It's that the only number that really matters (my body's ability to deliver oxygen to its cells) is out of order and all the other numbers that should show why aren't showing why since they come back normal. If I had been a pro-cyclist, people would probably be saying I had damaged my body through years of cheating. (isn't that what people are saying about Joe Papp right now? what they are saying about Fignon's cancer?)

I have to agree with TTF. There are medical professionals on this forum, including a hematologist if memory serves me correctly. This is not my field but I am a surgical oncologist and have a limited knowledge of doping and its effects. Over time, many of us have come to learn about doping and its effects. This also does not require a medical degree, just a level of interest and intelligence.

I am also a researcher and know how to do a medical literature review. It doesn't take a hematologist to realize that the changes in Armstrong's TdF possible are not possible naturally. In this or another thread, I provided three papers showing the progressive decrease in hematocrit over the course of a grand tour and intensive exercise in professional cyclists. I cannot find any documented case to show that hematocrit increases during a period of intensive exercise, especially a grand tour. More importantly, the hematocrit increasing while reticulocyte count remains low is also a physiologic impossibility by natural means because reticulocytes, or immature red blood cells, are a natural prerequisite for increasing hematocrit. If the hematocrit increases without a corresponding increase in reticulocytes, then a blood transfusion is responsible for this response.

I have long been a critic of the release of hematocrit levels without the corresponding total protein levels. Hematocrit can increase or decrease naturally with decreased (ie, dehydration) or increased (ie, overhydration) plasma volume. A corresponding total protein, which is run routinely with hematocrit in hospitals, would help determine whether an increased hematocrit is because of dehydration because a decreased plasma volume would result in a higher total protein count. So, increased hematocrit + increased total protein = dehydration, but an increased hematocrit + normal or decreased total protein = doping (EPO or blood transfusion).

Lastly, neither Joe nor Fignon are saying their illnesses are due to their doping. They have both raised that possibility - I believe Fignon's doctors said it was very unlikely and Joe is currently seeing his endocrinologist to determine the cause of his illness.

 

[Anonymous]

Sorry, but that is not what this thread is about. There are plenty of other threads to discuss whether a particular cyclist dopes or not. The issue at hand is an article with a very simplistic explanation of blood values and trends and the idea that one can now make declarations of guilt based on that surface level understanding of biology.

(fwiw, to be fair to the guy in Denmark, he said "it could be this, it could be that." it's unfair to him, and the cyclist, to just focus on the "this" without considering the "that".)

I'm not an Armstrong fan. I just think the witch hunt is ridiculous.

Then you obviously didn't REALLY read the article. It wasn't an explanation of blood values. It was commentary on how reading those blood values, when you understand the terms involved, makes that particular subject interesting. Your interpretation is simplistic, the reality is much more involved.

As to the "witch hunt," I think The Uniballer started that one when he chased down Simeoni and then carried on his personal attacks with others. It isn't about him being a doper to me as much as it is about him being a lying bully who deserves to be exposed for the fraud he is.

 

[Krebs cycle]

The suggestion is that we can all read one article, understand the biological passport, look at some numbers, and declare who has been blood doping or using epo. I don't believe it will be so easy.

No cyclist is going to get done for a positive doping infringement on the basis of what a bunch of lay people on the internet think, so this criticism is a moot point. The opinions that matter belong to experts.

 

[Ferminal]

Stephens, he admits he doesn't know anything about it and then makes a definitive statement that it could not happen naturally, which is in direct contradiction to the blood specialist in the report.

This guy was caught doing this in the LA blood values thread as well - you couldn't have a better example of why its wrong for people to believe they are experts from reading a few message boards. It's really not helpful at all. That particular user also makes definitive claims about LA's growth hormone levels that nobody else has ever made.

You just cannot trust internet forum experts who tell you they know something for certain. They really don't. Stephens you're totally right on that - they cause more confusion than they solve.

No he doesn't, he states that his knowledge is limited compared to a hematologists'. But I think you will find that elapid's education and experience put him in a much better position to interpret values than 95% of people here, keeping in mind someone like you sits in the group of blind trolls who have no idea regarding the science but continue to theorise and voice that uneducated opinion publicly.

Given your amazing education, have you been able to validate your claim that a cyclist can increase their HcT naturally during a hard mountain stage of a 3 week tour? Or that cyclists are highly susceptible to dehydration during a rest day? Or that returning from a fractured bone injury has a direct impact on HcT?

My knowledge on the subject is close to zero, which is why I refrain from posting. Perhaps you should consider a similar strategy.

 

[elapid]

No he doesn't, he states that his knowledge is limited compared to a hematologists'. But I think you will find that elapid's education and experience put him in a much better position to interpret values than 95% of people here, keeping in mind someone like you sits in the group of blind trolls who have no idea regarding the science but continue to theorise and voice that uneducated opinion publicly.

Given your amazing education, have you been able to validate your claim that a cyclist can increase their HcT naturally during a hard mountain stage of a 3 week tour? Or that cyclists are highly susceptible to dehydration during a rest day? Or that returning from a fractured bone injury has a direct impact on HcT?

My knowledge on the subject is close to zero, which is why I refrain from posting. Perhaps you should consider a similar strategy.

Thanks Ferminal. BPC does make me laugh sometimes and posts like the one you quoted justify why I have him on my ignore list. He distorts, misinforms, spins, and then cannot provide any verifiable proof to refute what is in the scientific literature. Thanks again.

 

[WonderLance]

No, no. That's precisely the wrong attitude I was talking about. You're a great example of why people like Elapid only add to the confusion. You are willing to trust him on this blood matter because he states he knows slightly more than most people. That's where the problem lies - people think he is credible and believe him, making his mistakes all the more damaging. If you read carefully he slips in the remark that he doesn't know anything about how drugs effect the blood levels, but then goes on to lie that the crit cannot go up naturally, yet we know Wiggins profile also went up at one point and was checked by the same blood specialist in Denmark who gave it the all clear. How can Elapid know better than the blood expert in Denmark? Then there are his claims about HGH levels that nobody else has ever made. How can you not be wary of someone who would do that? I smelt a rat from a mile off.

I, of course, was careful to explain that any piece of speculation I made was speculation - I was completely open. No pretence that I have some special inside view that most people do not have. Elapid, however, tries to pass himself off as if he in the know, and then makes a lot of bogus assertions, no doubt in the hope that nobody was paying attention. That type of misinformation is precisely why its wrong for people on forums to pass themselves off as blood experts. They're not.

Oh, but you do have a special inside view, you, unlike others in this forum are willing to admit when you are not an expert and this gives you a special inside view to the truth. When you dont manufacture evidence out of thin air you dont have to believe that riders are doing vampire like transfusions and mountains od PED's because there is no evidence of it. Why does everyone want to manufacture positives?

Thankyou for being the one shining light of truth in this crazy forum.

 

[Ferminal]

Which Danish expert are we talking about? Mørkeberg?

elapid's views are synonymous with Mørkeberg's but with the benefit of anonymity, is capable of expressing them to the full extent. Anecdotal evidence from this year's Tour combined with Mørkeberg's blood value analysis refutes the proposed counter-argument of -

"Has he for example had diarrhea and is dehydrated, it could mean an increase in blood levels"

You can even read the article this thread is about as an aid... Dehydration: Hgb is higher than expected, variable Retic, and performance is decreased.... Blood transfusion: High Hgb very low retic, maintenance of Hgb despite significant physical stress and low Retic.

Mørkeberg wasn't asked to comment on whether or not LA received a transfusion this year, he was asked to comment on what could have caused the HcT rise.

I, of course, was careful to explain that any piece of speculation I made was speculation - I was completely open. No pretence that I have some special inside view that most people do not have. "Elapid, however, tries to pass himself off as if he in the know, and then makes a lot of bogus assertions, no doubt in the hope that nobody was paying attention.

Yet you continue to use speculation to reinforce an argument, unless of course you've never moved off the fence. It is a fallacy to believe that a person can speculate and claim to be open-minded whilst holding a firm point of view.

WonderLance - If all you care about are "Official Sanctions" why do you visit this forum? The CN homepage will let you know when a rider has to take a two year vacation.

Apologies for destroying the thread.

 

[dopingectomy]

for understanding the biological passport, a picture is worth a thousand words:
http://www.doping.chuv.ch/en/lad_ho...ns-laboratoire-passeport-passeport-hemato.htm

 

[elapid]

Oh, but you do have a special inside view, you, unlike others in this forum are willing to admit when you are not an expert and this gives you a special inside view to the truth. When you dont manufacture evidence out of thin air you dont have to believe that riders are doing vampire like transfusions and mountains od PED's because there is no evidence of it. Why does everyone want to manufacture positives?

Thankyou for being the one shining light of truth in this crazy forum.

Ha. Thick as thieves and still neither of you can come up with reasons why Armstrong's (or Wiggin's) hematocrit increased during the TdF despite ALL of the scientific literature stating this is not possible. Here are all the papers I can find on hematocrit levels during GTs and intense training in professional cyclists:

Mørkeberg and others (Changes in blood profiles during Tour de France 2007. Ugeskr Laeger 170:1916-9, 2008) found significant decreases in hematocrit and hemoglobin concentrations in riders in the 2007 TdF on days 12 and 19 compared to the day before the prologue, with hematocrit 12.1% lower on day 19 compared to the baseline.

In another paper by Mørkeberg and others (Changes in blood values in elite cyclist. Int J Sports Med 30:130-8, 2009), which looked at hematocrit, hemoglobin concentration [Hb] and % reticulocytes in two professional cycling teams in 2007, they found that hematocrit and [Hb] decreased during in-season compared to out-of-season and, more importantly, during the TdF the [Hb] decreased by 11.5 %, with individual decreases ranging from 7.0 to 20.6%.

Lastly, Schumacher and others (Haemoglobin, haematocrit and red blood cell indices in elite cyclists. Are the control values for blood testing valid? Int J Sports Med 21:380-5, 2000) found that hemoglobin, hematocrit and red blood cell count decreased significantly with increasing training workload.

How is this manufacturing evidence out of thin air?

It does not take a genius or an expert hematologist to figure out what is going on when Mørkeberg states 1. increased hematocrit + low reticulocytes = blood doping; 2. increased hematocrit + very high reticulocytes = EPO; and 3. increased hematocrit + normal to high reticuolcytes = normal bone marrow response. Any doctor knows basic hematology, it doesn't take an expert to know these basics. These are also well summarized in the link provided in the OP: http://www.localcyclist.com/2009/09/a-tale-of-two-cyclists/#more-134

Lastly, as to those willing to declare their expertise, this is from my previous post which BPC continues to distort:

There are medical professionals on this forum, including a hematologist if memory serves me correctly. This is not my field but I am a surgical oncologist and have a limited knowledge of doping and its effects. Over time, many of us have come to learn about doping and its effects. This also does not require a medical degree, just a level of interest and intelligence.

So, to WonderLance and BPC, do you possess a level of interest and intelligence in this topic to produce a reasonable defence of Lance's atypical blood results or are you just going to continue to stroke each other's socks and produce the same ol' BS?

 

[Cobblestones]

for understanding the biological passport, a picture is worth a thousand words:
http://www.doping.chuv.ch/en/lad_ho...ns-laboratoire-passeport-passeport-hemato.htm

This is precisely what the passport was intended to deliver: Individual limits for each athlete which would be more stringent, but also more specific than the general limits we have in place at the moment. Look for instance at the limits for off score for this particular athlete. It's 54 lower limit and 100 upper limit. Not 133 which is the 'general' UCI limit.

Just as an example, Wiggins posted an off score of about 100 at Sion according to the published graph (see the thread on Wiggins). Now the athlete whose passport we're looking at is certainly not Wiggins, and when someone would construct individual limits for Wiggins, the higher limit might come up higher than 100, who knows. All I'm saying is that the current 'general' limit of 133 is very, very generous and highly unspecific. Furthermore, the values certain riders have posted, when scrutinized with the real passport system as it was intended might not look so innocent after all.

As another example, let's look at the retics. The athlete has a lower limit of 0.62 and an upper limit of 1.91. Armstrong, on his blog, posts retic levels of 0.5 for most of July. Again, Armstrong's individual limits, when properly constructed from the passport, might be lower than the ones for the anonymous endurance athlete here. This is not the point. What I really want to see is the passport used to its full potential with individual limits constructed and applied to stop riders from competing when their values become suspicious.

 

[stephens]

for understanding the biological passport, a picture is worth a thousand words:
http://www.doping.chuv.ch/en/lad_ho...ns-laboratoire-passeport-passeport-hemato.htm

This is a very clear presentation and it would be interesting to see charts for all the athletes. One thing it seems to be missing though is the time elapsed between each test. Surely if one test was a day after the other, one would expect much smaller changes being naturally possible than if the test was one month following the other. If tests are too far apart, one may see a change in hemaglobin, expect to see a corresponding change in reticulocyte, but fail to see that represented because the time between the tests has been too long. Surely the actual hematologists asked to analyze the data will take this into account, but laymen speculating on the intenet have no capability of doing so. Caution is advised.

Not considering the timing of the tests may also produce normal ranges for athletes that aren't truly accurate. What if an athlete is tested four times but each time corresponded to a certain phase of his training but inbetween those tests he was engaging in other types of training or racing that put his levels much higher or lower than would be shown in the four tests that were taken? His average would then be false because it totally ignored the data that would have been present had his tests been taken during his other training or racing phases.

Overall I like the concept of the passport because it allows levels to be established that are more accurate for a particular athlete, but am still cautious about its application, especially leaked numbers being presented for sensationalistic purposes by journalists without proper, controlled, analysis by official hematologists. (after all, newspapers are not above asking ten "experts" to look at the number and then picking the one whose comments were most sensational and publishing quotes from him to sell newspapers... while the other nine didn't see anything quite so 'newsworthy' in the data).

 

[Dr. Maserati]

This is precisely what the passport was intended to deliver: Individual limits for each athlete which would be more stringent, but also more specific than the general limits we have in place at the moment. Look for instance at the limits for off score for this particular athlete. It's 54 lower limit and 100 upper limit. Not 133 which is the 'general' UCI limit.

Just as an example, Wiggins posted an off score of about 100 at Sion according to the published graph (see the thread on Wiggins). Now the athlete whose passport we're looking at is certainly not Wiggins, and when someone would construct individual limits for Wiggins, the higher limit might come up higher than 100, who knows. All I'm saying is that the current 'general' limit of 133 is very, very generous and highly unspecific. Furthermore, the values certain riders have posted, when scrutinized with the real passport system as it was intended might not look so innocent after all.

As another example, let's look at the retics. The athlete has a lower limit of 0.62 and an upper limit of 1.91. Armstrong, on his blog, posts retic levels of 0.5 for most of July. Again, Armstrong's individual limits, when properly constructed from the passport, might be lower than the ones for the anonymous endurance athlete here. This is not the point. What I really want to see is the passport used to its full potential with individual limits constructed and applied to stop riders from competing when their values become suspicious.

Correct this is my main concern against the way the Bio-Passport has been used. (or under used)

This is from the UCI website on the Bio-Passport:
"In addition, the detection of abnormal levels will cause a rider to be declared unfit and to be suspended from racing for an agreed period of time."....

This is the final paragraph:
"Is the passport a turning point in the UCI’s anti-doping methods?

The biological passport is a great step forward. It is part of the continuous efforts already undertaken by the UCI to eliminate doping from cycling. The UCI has been a pioneer in the use of haematological parameters for the detection and prevention of doping activities since 1998.

What is new about this approach to anti-doping is that:

• it draws upon important new scientific methods of indirect detection,

• it uses sophisticated statistical tools to interpret results,

• it uses a sequence of tests to provide greater sensitivity in testing.

One thing is certain - this new approach will enable the detection of riders who use blood doping methods or endogenous steroids such as testosterone. Once a rider is included in the biological passport program, it will become impossible for him to escape detection if he uses blood or steroid manipulations to enhance performance.

We are closing the gap on cheaters. Those who dope will be caught. "

 

[Cobblestones]

This is a very clear presentation and it would be interesting to see charts for all the athletes. One thing it seems to be missing though is the time elapsed between each test...

Stephens, when you look at the spreadsheet, to the right, there's an option to display the values either 'ordinal' or 'temporal'. 'Temporal' does what you want. I assume they didn't do that for the publication to not compromise the anonymity of the athlete.

Also, beside the haematology, you could display the steroidology and endocrinology (and I assume construct individual limits there). I would like to see some of those graphs. Finally, when you look at the markers for haematology, there's the option to show 'tHGB mass', which I assume means total hemoglobin mass. I don't know if and how that is tested at present, but since that parameter has been shown to be very stable over time in the absence of blood manipulation, it could be a great indicator of doping.

 

[stephens]

Ah, thanks for that. I didn't catch it the first time.

 

[WonderLance]

WonderLance - If all you care about are "Official Sanctions" why do you visit this forum? The CN homepage will let you know when a rider has to take a two year vacation.

Apologies for destroying the thread.

Because someone has to stand up to your ridiculous, unscientific rumour mongering. Acting as if pro-cyclists are riding around with needles in their arms, look at how many riders are getting sanctioned, its just not happening.

elapid, can you tell us why a layman like yourself knows better than the blood specialist in Denmark who gave Wiggins' profile the all clear?

It's a simple question.

Another perfect point, well done. You really are slaying them in this discussion. Don’t let him comment as if he was any experience in this area.

 

[Krebs cycle]

Finally, when you look at the markers for haematology, there's the option to show 'tHGB mass', which I assume means total hemoglobin mass. I don't know if and how that is tested at present, but since that parameter has been shown to be very stable over time in the absence of blood manipulation, it could be a great indicator of doping.

I will try to find out where this is up to at present. Here's hoping the UCI brings the CO rebreathing method in as a sanctioned test because it really will be the nail in the coffin for blood doping in terms of marked performance benefit. It is still subject to a degree of error though, and there is likely to be a slight performance benefit within that margin, but the biggest advantage IMO of this method is that it is technically more difficult to conduct (but as accurate if not more) than regular blood testing, so the internal team 'doping controls' will have a much harder time trying to control the tHbmass than is possible with other variables such as [Hb] and retics. If they get the microdosing slightly wrong, then bam, they won't even realise that tHbmass has gone over the threshold for a positive test.


edit: also I thought of something else that is very advantagous. The results are ready within 20mins. If a positive test occurs it would be possible to conduct the test again to verify the results (which is what I suspect will be required for an official positive). there are cons as well of course, which is why i suspect it hasn't been introduced despite the fact the WADA funded validation study was complete 18months ago.

 

[Krebs cycle]

Because someone has to stand up to your ridiculous, unscientific rumour mongering. Acting as if pro-cyclists are riding around with needles in their arms, look at how many riders are getting sanctioned, its just not happening.



Another perfect point, well done. You really are slaying them in this discussion. Don’t let him comment as if he was any experience in this area.

what about the rumour mongering of the anti-doping scientific community? are you going to stand up to them as well wonderlance? because you should probably know that amongst this community it is accepted as undeniable truth that LA tested positive in 1999 and was blood doping from 2003 onwards. remember that these are the same people who invented the bio-passport in the first place. they have had access to these blood parameters since around 2000, so there is a huge mountain of data already available that remains confidential for legal reasons, but rest assurred, the experts who do have access to this data know for certain the signs of blood doping are all there.

but by all means, if you would prefer to live in your fairyland where the top end of the pro peleton is presently clean or has been at any time this decade, then go for your life

 

[mikkemus23]

because you should probably know that amongst this community it is accepted as undeniable truth that LA tested positive in 1999 and was blood doping from 2003 onwards. remember that these are the same people who invented the bio-passport in the first place. they have had access to these blood parameters since around 2000, so there is a huge mountain of data already available that remains confidential for legal reasons, but rest assurred, the experts who do have access to this data know for certain the signs of blood doping are all there.

Someone (with a concience) should leak the data - it is all for a bigger cause - exposing massive fraud.

 

[I Watch Cycling In July]

Part 2 is also well worth a read.

http://www.localcyclist.com/2009/09...-passport-part-two-of-a-tale-of-two-cyclists/

 

[Ripper]

Hi all, new here.

There is a lot of interesting stuff on this forum, and this thread is quite interesting. Thanks!

 

[Ripper]

***

That is one funny signature.