Anti-doping expert Parisotto speaks on blood passport

In the wake of the first results being announced from the UCI’s biological passport system, there has been some criticism of the fact that the five riders named on Wednesday were not big players in the world of cycling, and didn’t have the sort of recent palmares that you might expect in an otherwise clean peloton.

One who disagrees with this is Robin Parisotto, one of nine anti-doping experts appointed by the International Cycling Union (UCI) to analyse profiles and determine which ones are suspicious. The Australian defended the early results on Thursday, emphasising that the riders in question may have been working for others as domestiques, and therefore not chasing results themselves. He also stated that these five cases represent simply the beginning of the disciplinary process, and that more cases could well follow.

Cyclingnews: The first biological passport cases were announced yesterday, with five riders being recommended for sanctioning. What are your feelings on this, plus the reaction to the news?

Robin Parisotto: Well, I have seen that there has been quite a degree of criticism of the fact that the riders named were small fry. I think that is totally unjustified. Why should the success of any anti-doping programme be based on catching big names only? Certainly in the peloton, the reason why some big fish win is because some of the smaller fish are doping, as they in fact are helping the bigger ones. If they are doped, it may be the reason why they can go up hills so fast and break up the peloton.

So you can’t say that just because the programme is not catching the big fish that it is not a success. To me, a doper is a doper is a doper.

CN: Anne Gripper seemed to imply that there will be more riders added to the list as time passes...

RP: Certainly I would expect more cases to come to light in the future. I don’t think that just because there was an announcement yesterday that they are all going to suddenly pack up their blood doping gear and run away. I still think people are going to be at it. For that reason I would certainly back Anne’s comments up – these are not the last [announced passport cases] by any means.

CN: Do you think there could be more before the Tour?

RP: It is quite possible, because we are evaluating profiles every week. So there would certainly be opportunity between now and the start of the Tour to evaluate more of those and come to some sort of decision or consensus. Some of them could be just as compelling as the ones we have already assessed.

CN: In saying that you are analysing profiles every week, are they all suspicious or borderline cases?

RP: We get a cross-section of samples. Some may be normal, some will be slightly abnormal, and others may be more clear. But it doesn’t imply that these are all suspect.

CN: The biological passport was introduced just under a year and a half ago. There was a long delay as the UCI said that it wanted this to be watertight, legally....

RP: Yes, I think it is prudent that they do it very carefully. I am not sure that a lot of people appreciate it, but this is a pretty big shift in anti-doping to go from detecting a drug directly to indirectly detecting via seeing the effects of drugs.

Because this is such a shift, the UCI has to cross every t and dot every i. Even with direct drug testing, there are all sorts of legal loopholes that the athlete will try to take advantage of. So with this test you have got to be even more circumspect and be absolutely water-tight with your evidence.

From my perspective, I can understand the delay that was there, and from the public’s perspective I can understand the frustration. But the public has to understand that this is such a new thing.

CN: The 50 percent hematocrit was brought in back in 1996, whereby you could suspend a rider if he was over this level. When the biological passport was first spoken about, it was proposed that there would be a health suspension along the same lines as that hematocrit test, namely a No Start rule, and then there would be the more serious sporting sanction such as a two year ban.

Obviously the burden of proof has to be far higher for the latter. Yet the UCI are doing things in the opposite direction to what was originally intended, in that they are going after these long bans for a few riders rather than temporarily stopping a bigger group of suspect guys from racing. Are you surprised by that?

RP: Well, when me and Mike [Ashenden, fellow Australian anti-doping expert] first muted the passport a few years ago, we probably didn’t go the whole hog and say that you could actually use this test as a sanctioning one. We proposed at the beginning that it would be used like the 50 percent hematocrit test, or that it would be used for gathering intelligence.

But the sophistication of the modelling of the parameters is such that you could say with quite a fair bit of confidence that a profile is consistent with blood doping, whether that is done by EPO or blood transfusion. If you can exclude illnesses or any other factors that might influence blood parameters, you have got a very strong case that someone has blood doped.

CN: Do you think there is any possibility that there have been unannounced short-term suspensions by the UCI before now?

RP: I don’t know, but I do expect the UCI have been using the blood profiling data for intelligence. I am pretty sure they have targeted athletes who have given suspicious results in the past and I would say that they have actually caught some of the athletes.

As an example, do you remember [Raimondas] Rumsas from Lituania? He came third in the Tour de France one year [2002]. They suspected he was doping so what they did is they actually applied his data to the profiles that are used now today, and his scores were off the radar. So the next year they targeted him and they got him for doping just before that year’s Tour de France.

CN: There were high profile cases in last year’s Tour, such as Riccardo Ricco, Bernhard Kohl and Stefan Schumacher. Do you know if any of those riders had shown anomalies in their passports?

RP: The UCI doesn’t provide us with any identification of any riders [when assessing]. I might have seen some results which may be theirs, but I wouldn’t know.

CN: Kohl said recently that he was able to do blood transfusions without any biological passport problems. Do you have any reaction to that?

RP: Well, from what I have read, he was playing Russian Roulette. Not only with regard to transfusing blood, but from what I can gather the reports were suggesting he was actually taking EPO and growth hormone as well. It is like throwing petrol on a fire – you are blood doping and you are taking EPO – it is very, very risky.

CN: He said he took three blood transfusions in last year’s Tour, and said that he wasn’t detected. That said the French Anti-Doping Agency (AFLD) were doing the testing rather than the UCI there. So while Kohl is saying that he was able to dope and not get caught on the biologicalpassport, it’s possible that the AFLD could have seen something...

RP: Well, he may have been taking CERA or whatever, which was under the threshold limit for detection in the urine test. But in terms of blood tests, I don’t know, because I haven’t seen the results from him during that race. I suspect that if they have got results from the race on him, I certainly believe that there would be evidence to show that he was [doping].

CN: In order to combat drug transfusions, there are suggestions that a test for total body haemoglobin should be brought in...

RP: I certainly think it would be something that is well worth considering. It is a test that can be done on a fingerprick sample, so it is very easy to administer. From the research that I have read, it is a really good indicator that someone has manipulated their blood.

CN: T-Mobile were doing a test like this two years ago, their test involving the inhalation of carbon monoxide. Is that the same one you are referring to?

RP: Yes. Quite often they use that test in various sports institutes around the world to see what a person’s total haemoglobin is doing, and see if they can correlate that to performance. Seemingly the higher the total body haemoglobin, the higher your VO2 max.

CN: You were saying that it is quite easy to carry out the test. But from the athletes’ point of view, if they have to inhale carbon monoxide, will that have much of an effect on performance?

RP: No, I think they only have to breathe it for two minutes or something like that...I don’t know the exact details of it. Then you just take a blood sample, put it in an analysing instrument and away you go. Carbon monoxide displaces oxygen, but the amount they are breathing in is pretty negligible. I expect within a matter of hours or a day or two, that the carbon monoxide is being cleared.

CN: So would that lag in clearance prevent it being able to be used in races such as the Tour?

RP: Well, I haven’t seen any research which shows that carbon monoxide is detrimental to performance. But I guess if you are on the bike, you wouldn’t want to take anything that is detrimental, even if there was only a [small] risk that it was.

I think it is something that would probably need to be done at the very least a minimum of one day before, rather than during competing. Otherwise an athlete may refuse on the grounds that they feel it might decrease their performance. Yet it certainly could be used, utilised in much the same way as the passport - you could develop a profile over time.

CN: There have been some suggestions by people that by micro-dosing it is possible to maintain a relatively constant blood profile. Do you think that people could get around the biological passport by doping carefully and choosing how and when they do things?

RP: Well, the basis for blood doping is to maintain your haemoglobin levels or increase them. What normally happens just before competing in a big race and then during a big race, your haemoglobin level actually drops. So if a cyclist’s haemoglobin is maintained or increased during a race through micro-dosing, then that is very suspicious.

CN: But would it be possible for doping riders to do a year-round micro-dosing so that you don’t get these periodic changes in reticulocytes, etc?

RP: Well, in that case they would have to be micro-dosing with EPO all year round. It is risky at the best of times in terms of detection, but it is even more risky when you are actually dosing all the time. Even though something might not be able to be detected in the urine, there will be tell-tale parameters in the blood.

CN: What about the rumoured blood transfusions on the morning of mountain stages...can the biological passport pick up transfusions?

RP: Yes, very much so. What happens when you introduce more blood into the body is you see a spike in the haemoglobin and a decrease in the reticulocytes, the immature blood cells. Once it reaches a certain point, the body will actually turn off its own blood-making system. One of the models in the passport is called the Off model, and that is very sensitive to red blood cell stimulation or blood transfusion. What you see there is you see the Off-Score increasing and increasing over time.

As far as we know, there are only two ways of actually achieving that. One is blood doping, and the second is if you are actually in outer space! When you are in outer space, the lack of gravity and the fact that you are not moving around as much basically causes the body to turn off its blood-making system.

CN: The Tour de France will start soon. Are you confident that the sport is cleaner than in the past?

RP: Well, if you compare it back to 1998, absolutely it is cleaner. There are a number of reasons. One – you have not only got blood testing used as a tool for anti-doping thanks to the passport, but you have other information through police or customs and that sort of stuff. So the actual tool to detect doping has increased from a drug test to two or three other methods to detect cheating.

In the 1990s, all you had to do was hide the drugs and that was it. Now it is not only the drugs, you have got to hide the equipment, you have got to hide the doctors, you have to hide all the support staff that are involved in it.

The athlete has to monitor their own blood a lot more closely, probably a lot more often, probably with a lot more medical help. It will obviously require a lot more money, and will probably require a lot more subterfuge, keeping things quiet to cover their tracks. So just from that perspective, the passport has to make it a lot more difficult to hide blood doping because purely and simply it is going to mean a whole lot more time devoted to covering your tracks.

The passport is not a complete solution, but I do believe it is a big improvement.