Wednesday, July 2, 2008

Hit or Miss?

Researchers led by Dr. Carsten Lundby at the Copehagen Muscle Research Center have just published a paper on testing for EPO via urine sample. Lundby and company administered recombinant EPO to eight male subjects to track the performance-enhancing effects of the drug. While the results of this study are plenty revealing in their own right, in the course of performing this study the researchers decided to send the samples to two laboratories to see if the subjects would test positive using the current test protocol approved by the World Anti-Doping Association (WADA). The results of this study were just published by the Journal of Applied Physiology, a peer-reviewed journal.

The seven-week study began with a two week “boosting” period in which subjects received high doses of EPO, followed by a two week “maintenance” period of reduced EPO administration and ending with a three week “post” period. During this time some 32 urine samples were sent to each lab. In the paper the labs aren’t identified; they are just labeled “A” and “B.” Lab A found all samples from the boosting period positive. However, it only found two of 24 maintenance-phase samples positive.

Much worse was the record of the lab labeled “B” in the study. It didn’t identify a single sample as positive, and only determined only seven of the eight boosting period samples as suspicious; no other samples raised proverbial red flags for the lab. Lab B has since been identified as the Laboratory for Doping Analysis (LDA) in Cologne, Germany. The LDA is a WADA-accredited lab. It’s director, Wilhelm Schanzer said the study’s finding that the lab could not accurately identify recombinant EPO is “outright false.” He went on to say, “It’s not true that you could take EPO and not be detected.”

Schanzer went on to claim that because the samples were for a research project his lab didn’t perform all the tests necessary to verify a positive finding. He said under normal testing procedures his lab would have detected EPO accurately. He makes a great claim, but there is a problem with it: all of the samples were submitted blind. LDA weren’t told anything about the samples that might tip off the lab’s staff.

Perhaps more chillingly: One sample taken during the post period when theoretically no EPO should have been detectable was deemed positive by one of the labs.

BKW spoke to Paul Strauss of the Agency for Cycling Ethics to get some perspective on the issue. He began by saying, “WADA needs to look at this very seriously.”

The first observation he made was to note that the markers used to distinguish EPO depend on its production. He says the test WADA uses is optimized to find Amgen-produced EPO, while EPO produced in Mexico or China, and recombinant EPO can all escape detection if lab technicians only look for Amgen EPO.

Strauss also said that the criteria for a positive result can and do vary from one lab to another.

Ultimately, it may be that in the short term the best way to deliver clean riders to the start of races will come through programs such as Strauss’ Agency for Cycling Ethics, Paul Scott’s Scott Analytics or Danish physician Rasmus Damsgaard’s testing program.

“Longitudinal analysis which uses statistics to compare individuals and populations of athletes is very effective in raising a suspicion of doping in a particular athlete,” Strauss said.

However, even longitudinal testing has its own drawbacks. Strauss continued, “Its weakness is that it is not specific as to the exact drug being used. This leads to the problem of pursuing a sanctionable event for doping on a non-analytical adverse finding.”

It may be a foregone conclusion that catching athletes using performance enhancing drugs will remain an imperfect science. The question that remains: What we are willing to accept as the margin of error—the innocent or the guilty? What is the greater injustice: To allow some cheaters to escape detection and gain wins that shouldn’t rightfully be theirs, or to wrongly convict the occasional athlete who didn’t break the rules?

If we look to legal systems for parallel, this is where the United States and some European countries differ significantly. The American view of justice is that no innocent person should be convicted (in theory, if not in actual practice), while many countries, such as France with its Napoleonic Code, would rather scoop up a few innocents along with all the guilty. This characterization paints with a broad brush, but it seems a helpful way to frame what ought to be a conversation for how drug testing should be considered.

Even if Landis had succeeded in his defense, the result would hardly have been as damning as this study which was funded in part by the Danish anti-doping agency. The message is simple: Use recombinant EPO and finish your boost phase before the Tour starts; we won’t catch you.


Old Fonzie said...

the test WADA uses is optimized to find Amgen-produced EPO, while EPO produced in Mexico or China, and recombinant EPO can all escape detection if lab technicians only look for Amgen EPO.

All those years of my mom making me buy generic off brands has finally paid off.

Like I tell my buddies, if you put it in an Amgen hypo it tastes just the same.

Old Fonzie said...

Oh, just to explain the above post, I am ridiculing dopers.

Using Amgen EPO is bad enough just because of the known risks and side effects(I was afraid to use it during cancer treatment), but would you really want to use some shady off brand?

Look at the quality of legal supplements. For example, I heard a report on NPR yesterday about an herbal supplement study. The supplement helped heart patients, but it was a carefully monitored supplement. The researcher noted that off the shelf the herb had various levels of quality. Some even contained enough heavy metal to be considered poison -- and this was being sold above the counter, legally.

No way would I trust some pony medicine from China or Mexico just to ride a little faster.

Watts said...

The biological passport does an end-run around the detections issues by looking at the result in the body. This method would seem far more clear than chemical detection. We'll see how the Tour goes this year.....

Old Fonzie said...

Without adequate EPO testing, the bio passport is weakened. If you have your own hematocrit test machine and access to either a 7-11 big gulp dispenser or an IV bag you can easily keep your values balanced by adjusting the fluid level of your blood.

One red flag with the Bio Passports is you don't see riders above 50%. I'm an old guy who rides 350 miles per week and my normal hematocrit level before chemo was 51. I asked my doctor if that was high and he said the normal range is 40-54.

Why are pro cyclists under the UCI limit but not falling within a normal distribution curve for what is considered medically normal?

To me it seems like how normal traffic on a given road might be ten fifteen miles per hour over the posted limit, but you put a patrol car in plain sight with a loud radar gun and all of a sudden all of the traffic is at or below the speed limit.

Fortunately, there are other ways the anti-doping movement is enforced: peer pressure, steep fines and police investigations. Now that this info on EPO test problems has come to light it will only be a matter of time before better testing is in place.

I wouldn't be surprised if there are few scientists who read this report and are saying, "See,this is why we need to use my test!"

Anonymous said...

Great post. I also was alarmed, if that's the right word to use, by the study, and that was before I was aware of the lab director's weak excuses. It appears we have a long way to go in the fight against current doping practices, which will only get worse as dopers find new ways to get around the fixes that will hopefully come. I would suggest (for full disclosure, I know virtually nothing about biology or law) a broad initiative by the UCI, other sports' governing bodies, WADA, national anti doping groups, and the teams/athletes themselves to overhaul both the scientific and legal aspects of the fight against doping. The funds for such initiative should come from whoever has a stake in clean competition (the teams/athletes, governing bodies, labs...). This state of non-effective controls that are held up as being error proof by those who perform them is only hurting everyone involved. Every court case and consequent appeal (see Mr. Landis) represent time, energy, and funds that could be used to fix the problems once and for all rather than fostering the distrust in the system. That's my two cents.

Jim said...

WADA needs to look at this very seriously

Yeah, right. Point out that the emperor's clothes are a wee bit threadbare... Floyd just found out there isn't much profit in that, better to keep your mouth shut.

Nothing to see here, folks. Keep on moving.

bikesgonewild said...

...nice to be assured, a week before the tour, that there are no assurances...

...have a good race, guys...

Unknown said...

what happened to radio freddy and his posts about bike shops and cyclocross racing? i can read about landis and WADA at velosnooze. i want more commentary about things that other people don't already write way too much about.

SkidMark said...

Interesting point on American vice European justice. Great article, but still leaves me little hope for a clean future in cycling. Oh well, let's level the playing field - remove all controls and let ALL the riders drug up to the gills!