Can We See Your Numbers?

The biological passport program, was introduced to catch athletes using drugs to augment their blood profile, and thus performance. Since its inception in Jan 2008 over 980 riders have been part of this extended program and 13,000,000 euros spent to date.

The basic premise:  a rider who was taking illegal products to increase his aerobic ability, would have abnormal and inconsistent returns from regular blood tests. Periodical record of an individuals ‘blood profile’ would create a normal average control profile, and those seen to differ from the expected return would indicate the use of drugs to obtain the elevated levels.

Since its inception, the passport scheme has been dogged with suspicion due to the closed, secretive nature of the gathered information and the self-regulation of the tabulated results. It has been long said to make the passport scheme compliant with its core aims:  to weed out cheats and rebuild trust- it must be  (A) overseen by an independent body who would be completely unaffected by the results produced and  (B) each rider’s results displayed openly to be viewed and critiqued by concerned communities.

We wish to propose changes, ONLY, if it would not put clean riders in danger of being accused in the wrong and only, if it would improve both the image and integrity of our sport.

Bike Pure asked two experts in their particular fields was this feasible and possible for introduction? Firstly, we asked the Polish Internet guru who is working at the cutting edge of the online evolution, Bartek Czerwinski.

Is possible to create a website where 1000 riders or 10,000 athletes blood profile results could be displayed, live online?

Yes, this is not a difficult problem. It is really programming an intelligent platform with a server cloud infrastructure behind it. It is irrelevant if 10,or 100,000 athletes had their information held.

Is it then possible for 2 graphs to be incorporated into each athlete’s bio page, where their key results (‘Packed Cell Volume’  – Hematocrit + Packed Cell Volume’ HB -Hemoglobin) would be easily visible and the parameters highlighted?

Yes, It is possible to assign each Lab their ID number, access details and to limit the accessible information to that they upload. There may be a common XML or even CSV format provided that every lab would use to upload the information.

Any information sent on the Internet will have a timeline correlated to the specific Lab ID, so it will be transparent who sent what information, from where and when.

Could these athlete’s pages, be updated, securely in real time by the registered labs around the world?

Yes, It is possible to give each Lab their own set of passwords and to limit the accessible information to that they upload. Any information sent on the Internet will have a timeline from the specific IP address; So It will be transparent who sent what information, from where and when.

Could the website be program to contact the rider/team/UCI by email once a result had been up loaded out side the permitted parameters.

An automated response could be set up once say a given parameter is returned higher than permitted. With my limited knowledge of the passport scheme, a warning if it occurs once of if the lab results were consistently higher than demanded, all concerned parties could be individually informed instantly.

Could the website be protected from possible tampering?

Yes, with any issues of finance or personal information. Security is the uppermost importance. Everything could be protected from hacking or tampering. The technology is improving daily. The rider’s personal information could be protected from public view (but available to selected bodies) and only particular, crucial results open.

How much would a multi lingual site cost and how many staff would you predict to maintain it?

How many grains of sand in a bucket. All would be dependant on the complexity required. But it is possible, relatively simple and could be written and coded and tested in a matter of several months. The cost, ballpark of $25-35,000 and maintained by at least two, separate bodies, simply for compliance.

Next we interviewed Dr John Hardy, renal consultant who spends his day’s evaluation and improving collection of patient’s blood results, about possible pitfalls:

What is your view on the Passport system?

Basically the Biological Passport is a good idea. It recognizes that just like the “normal” population, individual athletes will demonstrate variation in levels of blood  (Haematological profile) and hormone (Steroid profile) parameters. Basically some will have higher than normal levels and others lower than normal. In general, successful athletes will tend to have blood parameters at the upper limits of normal – as that will confer a natural advantage to them in endurance sports.

Can you tell us why the current passport system may be closed?

I have no insight into the UCI’s protocols or why this would be the case, to be honest closed systems do not work and evoke suspicion. In Medicine there was initial opposition to publishing survival statistics on patient outcomes for Hospital and Doctors. Whilst there were and remain issues on interpretation of results, such publications have driven up the standards of health care and importantly improved the confidence of the public in the Medical Profession.

Should healthy riders be returning results outside the given blood parameters?

Although we would expect significant variation between individuals (inter variation) we would expect less variation within a single individual (intra-variation) in the absence of disease, physiological changes (dehydration, nutritional deficiency) or doping. I believe that a profile of 6 tests will be used to define a rider’s usual range. Each rider would therefore be acting as their own control.

These ranges (or limits) would be used as a foil to compare results from subsequent blood tests. Significant deviation from the established range would suggest the possibility of artificial manipulation of their blood parameters by doping (either using Erythrocyte Stimulating Agents (ESA’s – i.e EPO, Aranesp CERA) or transfusions.

However it should be recognized that abnormally high results for Haemoglobin and haematocrit could be obtained during periods of dehydration as these measures express the amount of haemoglobin or red blood cells in a given amount of plasma. Plasma contains water and during dehydration the plasma fraction falls artificially elevating the concentration of red blood cells or hemoglobin. This problem may be partially overcome by use of the Stimulation Index (a comparison of the ratio of Hemoglobin to immature red cells (reticulocytes)) – which is included in the Hematological profile.

Is a simple explanation enough to read a blood test result sheet or do you need a medical training?

Well I think for your proposal and sticking to the core requirement to identify a rider using a PED, one could simply look at the results which would be greatly affected by same or which could have an enormous effect on performance, But to make ANY judgment which could affect lives and careers, it must be reviewed by experts

The biological passport is not a perfect test.  For example a rider constantly doping and thus maintaining high hematological parameters would thus show no deviation from his / her artificially high range. In addition, a hematological profile can change over time due to better nutrition, Iron supplementation or training at high altitude – low oxygen (which stimulates increased production of “natural” EPO)

Key issues include

1. At what level is a value considered significantly different from a rider’s baseline result? Is significance determined by a statistical test or subjective observation?

2. How often will the profile be repeated and what are the ideal numbers of baseline tests that are required to build a valid profile?

3. How will an individual abnormal result be interpreted? After all that result may be due to a transient change in physiology rather than doping. For example, if I were to spend a month training at altitude or sleeping in a low oxygen tent I would expect (and hope) to see a significant increase in my hematological profile.

Peer review in such a system will assist with identifying and focusing in riders with questionable results.

Is the passport the way forward?

In the absence of a direct test for the actual doping agent it may still be impossible to say for certain if the result was as a result of doping. Cycling should do likewise and honest individuals should be able to adequately explain any deviation from their usual limits. Open publication will help to dissuade dishonest riders and coaches.