I tackled a theme not too long ago: The Biological
Passport. It is necessary to speak clearly
about it because bureaucrats want to be important like some of the referees in
a Football game. The biological passport
is just a parameter to consider when evaluating doping in somebody. Please see our post when the case of Mark
Fretta came to light:
As we can see in the Hematopathology / Automated Blood Cell Counts Am J Clin Pathol 2008;130:104-116
It is also desirable that,
as with the high standardization for basic CBC parameters, a continued effort
be made for the parameters (ie, RDW, IRF, MCVr, and MPV) for which results
provided are still too different when produced by different analyzers. To reach
these goals, cooperation between long-standing (ie, International Council for
Standardization in Haematology and the National Committee for
Clinical Laboratory Standards, now the Clinical and Laboratory Standards
Institute) and recent (International Society of Laboratory Hematology)
organizations interested in hematologic standardization and the manufacturers
is fundamental. It should be remembered that despite the essential role of
automation in the modern hematology laboratory, microscopic control of
pathologic samples remains indispensable, so much so that in certain cases, it
alone is diagnostic.134 Moreover, knowledge of the limits of the specific
analyzer in use is of paramount importance for the correct interpretation of
results. These considerations require that clinical laboratories performing
hematologic diagnostics have personnel with specific training and profound
knowledge in laboratory hematology.
We have to find the substance to make a case;
otherwise, we are not beyond a reasonable doubt. There is a criterion in the law that says: Beyond a Reasonable Doubt.
The standard that must be
met by the prosecution's evidence in a criminal prosecution: that no other
logical explanation can be derived from the facts except that the defendant
committed the crime, thereby overcoming the presumption that a person is
innocent until proven guilty.
Errors of measurement for
blood volume parameters: a meta-analysis
Christopher J.
Gore, Will G. Hopkins, Caroline
M. Burger
DISCUSSION
The most important results in the present study are the meta-analytic
estimates of error of measurement of VRBC and MHb, the
blood parameters directly related to oxygen transport. The short-term error for VRBC,51Cr and MHb,CO were ∼2.5%, whereas those for VRBC,Evans
or VRBC,CO were about threefold greater. Over a period of 1 mo, the
errors for VRBC,51Cr and MHb,CO were ∼3.5%, about one-half of
those for VRBC,Evans or VRBC,CO. The errors of
measurement for MHb,CO, VRBC,51Cr, and VRBC,Evans
also showed wide variation between laboratories, typically by a factor of
approximately ×/÷1.6. Thus a poor laboratory assessing MHb,CO and a
good laboratory assessing VRBC,Evans could have similar errors of
measurement (∼4%) and obtain similar precision in the estimates of effects on MHb
and red cell volume with a given sample size, but an even greater disparity
between the two methods is also possible. Unfortunately, we were unable to
estimate whether VRBC,51Cr shows substantial variation from
laboratory to laboratory, owing to a paucity of data.
We have to have the doping substance to be beyond a
reasonable doubt; otherwise we speak of weak evidence due to LABORATORY
ERROR. In the biological
passport we do not have the sample B to
decrease the chances of errors. In the latest case of Chris Horner who won La
Vuelta a España, the chances of doping are high; not because of the biological
passport, but because doping is endemic from what we know of Xavi Llobet and different
operaciones in Spain.
Outside Online
Tuesday, October 22, 2013
Tuesday, October 22, 2013
Chris Horner's Bio Passport Problem
On Sept. 25, in what appeared to be a good-faith effort at transparency,
Horner released his bio passport data to the public. But the move seemed to
raise more flags than it lowered. We checked in with Michael Puchowicz M.D., a
sports medicine physician for the Arizona State University Health Services and
author of the Veloclinic blog, to see how Horner’s
bio passport numbers hold up under anlaysis. Conclusion: Not very well. Here,
Puchowicz explains why:
Chris Horner’s blood values
during the Vuelta better fit with the patterns that anti-doping authorities
look for as signs of cheating. The first element of Horner's bio passport that
raises concern is the hemoglobin concentration. Hemoglobin is the
oxygen-carrying protein inside red blood cells. In endurance sports, athletes
seeking an advantage have been known to use EPO or blood transfusion to
increase their total hemoglobin. The biological passport tracks the hemoglobin
concentration as an indirect marker of EPO use or blood transfusion. Anytime
that the hemoglobin concentration is higher than expect it is an indication
that EPO or a blood transfusion may have been used.
Above is Horner's complete
hemoglobin concentration data from his published bio passport, spanning from
early 2008 to September 2013. The Vuelta values are highlighted in red.
No solo se dopan los profesionales
Carlos Arribas
Si la Operación Cursa pudo ser
considerada como una más por una sociedad a la que cada poco se le sobresalta
con un nuevo golpe policial contra el dopaje, para el sargento Xavier Tarrés,
jefe de la Unidad de Consumo de los Mossos d’Esquadra, supuso entrar en un
mundo oscuro que sospechaba que existía, pero del que nadie tenía constancia
documentada. Dirigiendo la investigación de una red de tráfico de sustancias
dopantes con ramificaciones en Portugal, Andorra y varios hospitales catalanes,
Tarrés, que comenzó su carrera como escolta de Jordi Pujol, entró de pleno en
el mundo del dopaje que invade el deporte llamado aficionado o popular. Confirmó
así lo que ya imaginaba, que no solo se dopan los campeones y los deportistas
profesionales, sino también los participantes en las medias maratones o en las
carreras populares o en las sansilvestres
de fin de año, llamadas cursasen
Cataluña. Por eso Tarrés bautizó a la investigación Operación Cursa.
“El producto estrella era
Actovegyn, un concentrado de sangre de ternera, al que llamaban EPO de los
pobres”, explicaba hace un par de años en una conferencia antidopaje. También
describió la Operación Cursa como la primera desarticulación de una red que
suministraba al deporte aficionado. “La lógica económica de las redes de
tráfico exige también fomentar el consumo”, explica Enrique Gómez Bastida,
director del departamento de inteligencia e investigación de la Agencia
Española Antidopaje (AEPSAD) y que como teniente de la Guardia Civil dirigió
diversas operaciones contra el dopaje, incluida la Operación Puerto. “La
ganancia se consigue vendiendo EPO a corredores de San Silvestre. En todo caso,
los profesionales sirven para hacer publicidad indirecta de las bondades del
producto”.
Restringido antes a los gimnasios
en los que adeptos al culto del cuerpo lograban kilos de calidad y forma no
solo subiendo hierro sino con anabolizantes del mercado negro —muchas veces
falsificados o provenientes de desvíos de pedidos de farmacias—, la
masificación del running y del
cicloturismo ha aumentado el espectro de productos y vendedores. En Valencia la
policía bautizó una operación Master porque los clientes de la trama eran en
gran número participantes en pruebas Master, categoría de veteranos de
ciclismo. La Skype, llevada a medias entre los mossos del sargento Tarrés y la Policía Nacional, destapó una
banda que operaba en una tienda de suplementos nutricionales de Mataró y con
ramificaciones en Marruecos, Colombia y Madrid. Junto a atletas excelentes,
como el campeón olímpico Rashid Ramzi, y decenas de atletas marroquíes que se
ganan su sustento participando en carreras locales con premios, entre los
consumidores detectados había ciclistas y runners populares, y hasta alumnos de un centro de formación de
opositores a bombero en Móstoles.
There is a conversation in Spanish where the ironman
competitor Xavi Llobet is asking to a drug dealer over the phone for doping
substances when an undercover agent was listening to the conversation.
Xavier
Llobet, triatleta olímpico en Atenas 2004, habla por teléfono con el exciclista
del Kelme Jordi Riera Valls. Son las 9.54 del 1 de febrero de 2011. Riera tiene
el teléfono pinchado dentro de una operación policial sobre dopaje. Hablan en
catalán. “¿Qué pasa, crac?”,
es el saludo. Tras comentar brevemente su plan de entrenamiento pasan a la
farmacología.
Riera. Los Actos salen a 150.
Llobet. Vale...
R. Cada caja.
Ll. Vale.
R. ¿Lo digo bien? Sí, vale.
Ll. Vale, ¿qué más?
R. ¿Cuántas quieres?
Ll. Oh, tres. Son 350.
R. Después, el clembu a 60.
Ll. Vale.
R. Después, ¿algo más de aquello?
Ll. No, porque todo lo otro ya lo
tenía, ¿no?
R. Bueno, ¡el tratamiento aquel!
Ll. Sí.
R. ¿Lo quieres hacer? Yo, yo, es que,
Xavi, lo tengo, lo tienes muy... lo conté para hacer 12 pinchazos.
Ll. Pues venga.
R. O sea, seis, seis inyecciones que
te las puedes ir combinando. Tienes para mucho, eh.
Ll. Vale, ¿entonces a cuánto sale esto?
R. Esto sale cada inyección unos 30
euros.
Ll. O sea, has dicho seis: seis por...
tres, ¿18, no?
R. Ahí.
Ll. Vale, pues esto así. Vale. Yo
ahora...
R. Así.
Ll. Cero, diez, diez, quince, quince,
me llevo una, son 750 euros.
R. Vale, y aquí entran tres Actos,
dos...
Ll. Dos, dos cle, clembu y seis, seis
inyecciones de aquellas.
R. ¿Dos clembus quieres o uno?
Ll. Uno, uno, uno, uno, uno, sí pon
uno, pero después ya es menos. Después son seis... Bueno 700, 700.
R. El clembu cada caja cuesta 60, pero
van más.
Ll. Pues 700, al final son 700 euros.
Justos.
R. Vale, espera, tres Actos, un
clemb...
Ll. Y seis de aquellas que me has
dicho.
R. Y seis de aquellas, que entonces
serán aquellos tratamientos para los males que uno era el Testo. Que después te
tengo que explicar cómo se tiene que hacer.
Ll. Vale.
R. Esto lo tendré esta semana quizá.
Ll. Bueno, y con lo otro también, ¿no?
R. Sííííí y lo otro tío, que tienes
Andriol, y tienes de todo ahí.
Ll. Vale, entonces.
R. Y, y un huevo de Aire.
Ll. Vale, pues yo ahora lo preparo y te
lo doy ahora aquí cuando...
R. Tres Actos, un clemb y seis
inyecciones de aquellas. Ah, y te he guardado una cosa...
Ll. Sí.
R. Y quiero que lo pruebes esto,
bueno, eh, es muy caro.
Ll. Mmm.
R. Pero compraron muchos y dijo,
ostras, y cada uno, uno de nosotros se queda...
Ll. Mmm.
R. ... Dos ampollas. Una me la he
quedado yo y la otra... te, te la daré a ti de regalo.
Ll. ¡Hostia! Vale, vale, guay,
perfecto.
R. Y una de estas es como cuatro HMG.
Being devil´s advocate in the Horner´s case regarding
doping, I will show you what people do to their bodies. We should know the routines done to lose
weight by limiting water in fighters.
This routine changes drastically the hematocrit and red blood cells
percentage in a matter of 24 hours.
STRATEGICALLY DECREASE WATER CONSUMPTION
Routine to lose 20-30
pounds.
Dropping weight fast is all about manipulating your water and sodium
levels.
For a fighter who wants to cut weight quickly and safely, here’s how
much water he would consume in the 5 days leading up to his weigh-in:
Sunday – 2 gallons
Monday – 1 gallon
Tuesday – 1 gallon
Wednesday – .5 gallons
Thursday – .25 gallons
Friday – No water till after weigh-in at 5PM.
Monday – 1 gallon
Tuesday – 1 gallon
Wednesday – .5 gallons
Thursday – .25 gallons
Friday – No water till after weigh-in at 5PM.
As you can see, the amount of water starts high with two gallons and
decreases with each day till he’s drinking hardly any water on Thursday and
Friday.
This is to ensure their body gets into “flushing mode.”
By drinking lots of water early on, the fighter’s body will
down-regulate aldosterone,
a hormone that acts to conserve sodium and secrete potassium.
And when he suddenly reduces the amount of water he drinks in the middle
and end of the week, his body will still be in flushing mode, meaning he’ll hit
the bathroom to pee a lot even though he’s hardly drinking any water.
What happens when you excrete more fluid than you take in? Bingo! Rapid
weight loss.
DON’T EAT MORE THAN 50 GRAMS OF CARBS PER DAY
Since one gram of carbohydrate pulls 2.7 grams of water into the body,
it’s important for fighters to keep their carb intake low.
By doing this, they also deplete muscle glycogen (a source of energy)
and keep their body in “flush mode”.
DON’T EAT FRUIT, SUGAR,
OR STARCHES
These are carbs that should be avoided entirely while cutting.
EAT MEALS THAT CONTAIN A LOT OF PROTEIN AND FAT
Fighters have to eat something.
Since they’re avoiding carbs, Dr. Berardi advises them to load up on
high-quality protein like meats, eggs or a vegetarian sources of protein. It’s
also the perfect opportunity to eat lots of leafy vegetables (like spinach) and
cruciferous vegetables (like broccoli and cauliflower).
Georges St Pierre normally has his meals prepared by a private chef so
he doesn’t even have to think about this stuff or make decisions. Recommended
reading: here’s an
entire article detailing GSP’s training diet.
DON’T EAT SALT
Since the body likes to hold on to sodium (which will hold on to water),
dropping salt helps the fighter’s body flush water out.
CONSIDER A NATURAL DIURETIC
This step isn’t always necessary, but it can help when you’re getting
down to the wire and still need to lose water. Opt for a natural diuretic like
dandelion root, but wait until the last 2 days to use it.
TAKE HOT BATHS
We sweat a lot in hot environments. However, we sweat the most in hot,
humid environments. Since hot water offers both heat and 100% humidity,
fighters lose water quickly by taking hot baths and fully submerging everything
but their nose for 10 minutes at a time.
SIT IN THE SAUNA
This is the “finishing touch” to flush the last few pounds of water and
is only used on the last few days leading up to the weigh-in.
Does the weight
loss routine look like the tour de France?
It is not precisely, but it should be known by the “experts” on the
Biological Passport to learn more about inter individual variations. As I said, if Horner doped or not, it will
not be answered by the Biological Passport.
The chances are high because doping is endemic and not because he was
caught by the Biological Passport.
