21 nov. 2012

BIOLOGICAL PASSPORT AND TRIATHLON



After the affidavit written by George Hincapie:
It is worth taking a look at the biological passport.  Mark Fretta is the first one I know suspended when followed by this method. Is this our gold standard?
As new diagnostic methods become available, the "gold standard" test may change over time. For instance, for the diagnosis of aortic dissection, the "gold standard" test used to be the aortogram, which had a sensitivity as low as 83% and a specificity as low as 87%. Since the advancements of magnetic resonance imaging, the magnetic resonance angiogram (MRA) has become the new "gold standard" test for aortic dissection, with a sensitivity of 95% and a specificity of 92%. Before widespread acceptance of any new test, the former test retains its status as the "gold standard."

To take the biological passport as a “gold standard” we need to do more work, and we should continue with our “gold standard” which consists in “finding the doping substance.”  For instance, we do not have standardized procedures to measure erythrocyte production without the doubt of making an error. 

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 can end up having a problem as pointed out by the innocent project:
The Innocence Project is a non-profit legal clinic affiliated with the Benjamin N. Cardozo School of Law at Yeshiva University and created by Barry C. Scheck and Peter J. Neufeld in 1992. The project is a national litigation and public policy organization dedicated to exonerating wrongfully convicted people through DNA testing and reforming the criminal justice system to prevent future injustice. As a clinic, law students handle case work while supervised by a team of attorneys and clinic staff.

It doesn't change much if we take drug enhancing when we do not have the proper technique and speed.  We can have an athlete with a high VO2 max like Macca, but if he does not “know” how to go fast he will never be fast.  Increasing hemoglobin does not make us fast, we need to be fast and then improve endurance by doping if you believe in it.  As a devil´s advocate, I want to find the drug first instead of having this gold standard.  It all gets backs to education.  If you do not have the proper education to improve technique, nutrition, recovery and basic education, it does not matter what you do to improve your speed.  It is the case of Fretta, if he doped, his last two years competing have nothing remarkable, just look at him running! He does not have the capacity of going fast.  You win triathlons running.

What Hincapie said gives an idea of how endemic doping is in cycling and how the justice system works.  We still need “DNAs” to have a real “gold standard.”

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