The Explainer: Legalize it?

Hello Charles,
I hope all is well with you and yours.

I know that you are immersed in the Live Updates and your practice at this time of the year but the latest charges against “The one who will not be named” started me thinking about one of the most quoted arguments I hear against continuing this investigation. On any story about this I hear people say, “Well everyone was doing it so it just leveled the playing field.”

On the surface, this sounds like a logical assumption, but like many logical assumptions, it may not stand up to daily reality. I have been trying to come up with a name of any athlete that was busted for PEDs, who returned, without PEDs, and was back at the top of their sport? In cycling, only David Millar and Ivan Basso continue to contribute to their team, but I don’t think anyone can argue that they are anywhere near the same competitive level in the peloton as before the ban.

So if that is the case, does that mean that the peloton is still doped, or was the peloton not as fully doped in the 1990-2007 era as some are stating? Looking at average speeds and some passport info that has been available, I would tend to believe the peloton is cleaner now, but reformed dopers are not back on top. So would it be reasonable to assume if the peloton were cleaner then, the podiums would have looked different, and the only reason for the people winning was the PEDs? In other words if no one was on PEDs then Riis, Ullrich and Armstrong would not have been winning tours.

Without the “Everyone’s doing it” argument, the “Sporting fraud” argument really stands out, hence the need for this trial.

Does any of this make sense?

Trying to stay classy,

– John in Milwaukee

Dear John,
You do raise one of the most common arguments used to justify doping. Los Angeles Times columnist, Joel Stein embraced the argument in a July 2006 column – “Level the playing field with cheating, doping, lying” – which, it should be noted, came out before news of Floyd Landis’ positive.

I don’t think it’s the cheating, or the medical danger, that makes people hate doping so much. They only hate it because it seems deeply unfair.

That’s why, to level the playing field, we need to legalize doping.

Gee, makes sense, right?

Well, it’s worth looking at just how level that playing field would be.

While the debate focuses on legalizing all performance-enhancing drugs, let’s just focus on what we must assume to have been the most commonly used pharmaceutical booster used during that “Golden Age of Doping,” synthetic erythropoietin – what we all have come to know and love as “EPO.”

Cycling’s Mo’ Better Blues
Now back in the cruder days of doping, before the UCI even bothered to manage hematocrit levels, the bravest riders in the peloton simply took a “more-is-better” approach to the question. In other words, if a little EPO would boost your performance, then a lot of EPO would really ramp things up for you. There was a reason Bjarne Riis’ nickname in the peloton was “Mr. Sixty Percent” and it had little to do with his score on that biology test he obviously flunked in high school.

In that environment, the playing field would be leveled only if riders would be willing to ignore the obvious risk factors of blood clots, thrombosis and cardiac arrest. With 60+ percent of your blood volume made up of red blood cells, your oxygen-carrying capacity would be phenomenal, but the viscosity of your blood would be akin to that of Jell-O™. Obviously, there would be something of a transient advantage for those riders willing to assume more risk … at least until they got to the point at which they died.

In his 2007 book, “The Death of Marco Pantani,” Matt Rendell quotes an unnamed cyclist who recounted the practice of riders sleeping with heart monitors set to trigger an alarm if that rider’s pulse rate were to drop below a given rate. Riders would then wake up – or be woken up – and ride rollers for a few minutes to get their pulse rates back to a point where the heart could comfortably pump that sludge through their circulatory systems.

“During the day we live to ride, and at night, we ride to stay alive,” the rider is quoted as saying.

Sometimes, it didn’t work. As you might recall, there was a spate of deaths of young, seemingly healthy, cyclists back in the late 1980s and early 1990s. More than a dozen cyclists died in their sleep, a horrible statistic that then UCI president Hein Verbruggen told me was an unfortunate coincidence of deaths that could be attributed to pre-existing heart conditions and not on illicit drug use. Of course, those deaths were also coincident with the commercial availability of EPO.

All of that changed for the better in 1996 when the UCI took the first significant step in addressing the problem of EPO use (and both autologous and homologous blood doping) by setting an upper limit on riders’ hematocrit levels. Based on data from a fairly large population sample, the UCI concluded that the mean hematocrit level was 45% in a healthy adult male. By taking the mean, plus two times the standard statistical deviation – or 50% – that standard should cover 95 percent of the population. Two-and-a-half percent would deviate below that range, so they would not present an enforcement problem. The other two-and-a-half percent would naturally exceed 50%, so those riders would have to provide medical records to justify their claim that they fell within that group.

Indeed, at the 1999 Tour de France, there was a ripple of excitement in the newsroom on the day of the prologue, after reporters learned that three riders had exceeded the 50% limit on their pre-Tour medical exams. The UCI soon followed-up saying that the three were able to prove that they had naturally higher rates than that and that three riders out of a population of 189 riders fit within a predicted statistical profile.

So, did that level the playing field?
While the 50% limit did address the immediate safety concerns, critics were justified in saying that it also just established a “license to cheat,” but with an upper limit attached.

If you look at hematocrit data over the years after the imposition of the 50% limit, you will notice that there was a discernible increase in mean hematocrit levels among cyclists. In other words, the data used to establish that limit showed the mean to be 45%. Among cyclists after the limit was imposed, it inched upwards to around 47.3.

There were some notable examples of that. In the 2004 case involving Tyler Hamilton, USADA submitted blood profiles dating back months before he was cited for homologous blood doping at the Vuelta a España. Back at the Tour of Romandie, he purportedly had a hematocrit of 49.2%. That would vary over the months, but USADA also pointed out that medical records showed that Hamilton’s natural hematocrit level was closer to 41 or 42%. He was not the only one whose levels fluctuated.

Now in his “Level the playing field” article, Stein seems to suggest that it would be fair to let everyone ride at – or just below – 50%. It would, theoretically, be a quite level playing field, no?

No, it would not and here’s why.

First, there are qualitative as well as quantitative changes that occur in the blood profiles of riders using EPO.

In a 2001 study conducted by the Australian Institute of Sport – “Detection of recombinant human erythropoietin abuse in athletes utilizing markers of altered erythropoiesis” – researchers found that different test subjects react differently to identical levels of erythropoietin and even to identical hematocrit levels. My 50% hematocrit might provide more or less oxygen transporting capacity than your 50% hematocrit level.

We are, after all, men and not machines. Taking the approach that might work in establishing standards for bikes or Formula 1 racing cars and trying to apply that same standard to human beings doesn’t always work.

And those individual variations may best answer your question about returning dopers.

What doping appears to have accomplished is to select a new population of highly trained, talented and strategically savvy athletes who may have been genetically pre-disposed to derive the maximum benefits from the added boost of performance-enhancing drugs. That doesn’t necessarily mean that those same athletes would necessarily rise to the top in a world of clean riders.

Now let assume for the sake of argument only – I am, after all, doing my best to remain “classy” – that the top 20 finishers of the Tours de France, between Riis’ win in 1996 and Landis’ win ten years later, were all juiced to the gills. Stein’s playing field would be level, right? Wrong.

Were that hypothetical scenario true, it would merely show that the athletes who derived the greatest benefits from doping emerged at the top of the heap in those years. Were the reverse true – that no one had doped – we might see an entirely different set of riders at the top of the results list. We will never know.

So when a rider suspended for doping returns to the peloton, assumedly now clean, and begins to ride not as top GC rider, but as a strong lieutenant, that doesn’t necessarily mean that the riders currently at the top of the results are continuing to dope.

We see slower Tours these days. Times up climbs like l’Alpe d’Huez have actually declined since the record-setting days of the late 1990s and early 2000s. When taken in their entirety, the numbers seem to suggest that cycling is cleaner these days.

Risks both known and unknown
Finally, the level-the-playing field crew fails to take into account the unknown risks of pharmaceutical use, even if it’s seemingly benign at the time.

We all remember Dr. Michele Ferrari’s now-infamous statement that “EPO is not dangerous, it’s the abuse that is. It’s also dangerous to drink 10 liters of orange juice.”

As offended as people were at the time, Ferrari’s assessment was actually pretty reasonable. Anything used in excess presents a danger. He was merely suggesting that medically monitored use of certain drugs, like EPO, might not pose a danger to riders.

Well, on the surface, that actually makes sense. Careful medical monitoring would probably help riders avoid those late-night cardiac deaths. However, that monitoring is conducted with the best medical information available at the time. The long-term consequences of that use may not be part of the picture.

There were, for example, concerns raised about the effect recombinant erythropoietin might have on the body’s ability to produce its own after long-term use.

And we may learn of other consequences only when sufficient data has been collected. For example, in past years, one common recommendation for cancer patients suffering from chemo-induced anemia was to inject something known as “ProCrit,” an EPO variant that would help boost declining red counts. Indeed, I even asked my doctor about that when my own hematocrit levels dropped below 30 last year while I was on chemo.

Nope. The doc said that the Food and Drug Administration had issued a “black label” warning against that use, because the rate of cancer recurrence was actually higher among those patients than those who did not get the injections. Carefully medically monitored does not mean that the law of unintended consequences doesn’t apply.

So, this “level playing field” argument would simply mean that anyone hoping to compete at the top tier of the sport would have to assume – or ignore – the potential risks of taking drugs, simply to participate in the sport we love.

Call me crazy, but I’d much rather see the halting – and hopefully improving – efforts of WADA, USADA and the rest of the pee-in-the-cup crew than I would a laissez-faire approach that would relegate clean riders to fighting it out for lanterne rouge “honors” at the world’s greatest bicycle races.
– Charles

The Explainer is a weekly feature on Red Kite Prayer. If you have a question related to the sport of cycling, doping or the legal issues faced by cyclists of all stripes, feel free to send it directly to The Explainer at Charles@Pelkey.com. PLEASE NOTE: Understand that reading the information contained here does not mean you have established an attorney-client relationship with attorney Charles Pelkey. Readers of this column should not act upon any information contained therein without first seeking the advice of qualified legal counsel licensed to practice in your jurisdiction.