Can the biological passport stop doping?

Or will it spur on new doping innovations?

As the summer heats up and endurance sports are in full swing, so are fresh doping accusations in cycling and on a massive scale in track and field. Most of these doping accusations involve the manipulation of red blood cells.

The more red blood cells an athlete has, the more oxygen he can carry to improve endurance performance. That’s why blood doping has been the dope du jour since the 90’s. Blood doping is done in one of two ways: infusing red blood cells – which is risky and less popular, or injecting erythropoietin, or EPO, the substance made in your body that stimulates red blood cell production.

But unless an athlete and his team makes a huge mistake, it’s almost impossible to detect full-blown blood doping. The advances in doping techniques have always outpaced those of testing, and testing is only done periodically, usually after advance notice. That means athletes know when to dope and when to clean up based on the testing schedule.

The biological passport, which debuted in 2009, is the latest attempt to even the playing field. The principle of the biological passport is to monitor changes in red blood cells and hormones over time to reveal the effects of doping, rather than the doping substance itself. The hormone testing is still under development, so let’s take a look at the blood testing module.

Like all cells in our bodies, red blood cells have a lifespan. It takes them about a week to turn from baby stem cells into red blood cells, then they live for about 120 days (fun fact: dead red blood cells make your poop brown).

The biological passport testing can track the ratio of young and old red blood cells. If you take EPO, that increases the amount of young red blood cells. If you infuse red blood cells, that increases the amount of old red blood cells.

One strange number doesn’t really tell us much. But strange trends in that red blood cell ratio over time could indicate blood doping. In other words, there’s no specific number that equals doping; each athlete has a unique pattern that must be analyzed. Here’s what the data looks like in a “clean” athlete (more on that below) and a known doping athlete:Slide1

Without even looking at the numbers with a microscope, you can see that the “clean” athlete has, well, cleaner lines, and the doping athlete has a bunch of big spikes and dips in his data. But the blood testing isn’t perfect. Red blood cell cycling depends on many factors, including training, altitude exposure, genetics, etc. In order to prevent false positives – a test that indicates doping in a clean athlete – the test is intentionally insensitive.

Despite its imperfections, the passport has been effective, especially in the bottom tier of elite athletes. Since its introduction in 2009 many athletes have been caught and sanctioned (mostly Italians and Russians for some reason), and it was extensively used in the case against the best and most-hated athlete ever, Lance Armstrong.

But since the 2012 London Olympics, we’ve seen some outstanding endurance performances. And many of those athletes that have put up other-worldly performances, like this guy, have had perfectly clean biological passports. Still, skepticism remains. Why?

The use of the biological passport may have unintended consequences. In fact, it may be doing more harm than good.

All that new data available to athletes and coaches as a result of the passport has given them new insights into doping techniques. This has given rise to the most advanced technique yet: micro-dosing, or the use of sequential smaller doses of substances like EPO that are just enough to get a boost, but too small to cause those spikes and dips in the graph above.

The fight against doping is one sticky wicket. Whether more data helps or hurts that fight remains to be seen.

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