Medication and long-distance cycling: post 600 thoughts

June 19, 2014
Desgrange on a bike

Henri Desgrange rides a Brevet Randonneur

I have written a lot about doping here, especially in relation to competitive cycling. Since I do not race, this is fairly neutral territory, and I can at least maintain a degree of objectivity. Recent discussion of the use of strong pain killers such as Tramadol, and of medical interventions for asthma and other respiratory issue in professional cycling, and my recent encounter with pain and injury has brought this all a little closer to home. Any medication can enhance performance, and the ethical issues here are complex: many athletes could not compete at all without asthma medication, and there are many situations where anti-inflammatory medication or an analgesic would be perfectly reasonable to enable someone to continue with a minor injury. I would suggest that there are three issues that limit such medical intervention in competition, notwithstanding chronic conditions which require maintenance:

  1. the injury or condition should not be made worse by the use of medication;
  2. the medication should not enhance the athlete’s performance above their baseline without such medication; and
  3. the medication should be within the rules of the sport.

Read the rest of this entry »


Frustration

April 24, 2014

It is easy to become frustrated with the limited success of anti-doping. What with the post-EPO world of xenon-therapy and AICAR, seemingly bizarre inconsistencies of sanction, and the fact that riders, team-staff and management still reflect a past which is surprisingly present it would be easy to respond by

  1. giving up watching
  2. advocating legalisation
  3. posting pictures of veined legs in an attempt to fight doping with humour

Although I have, to my regret, already resorted to approach #3, I am not ready for #1 or #2, but that time may come.

I’ll try to outline a some issues that have been on my mind recently, in an attempt to shed some light on how my thinking is evolving.

We are winning the war on doping

No we are not, and indeed it is arguable that eradicating doping is a foolish, quixotic errand (cf. alcohol prohibition/recreational doping). There is evidence that certain kinds of doping are being used less, or at least in smaller doses, but there is also evidence that other kinds of doping are becoming more widespread. As EPO becomes more detectable, along with blood transfusions, it does not disappear. Riders and doctors begin to consider new methods of performance enhancement, some already banned but hard to detect if administered carefully, some yet to be banned and as yet impossible to detect. The bio-passport, like the 50% rule before it, limits the extent of blood manipulation, but does not eradicate it. Even supposedly anti-doping teams consider the ethics of methods that artificially raise natural EPO production before rejecting them, and the boundaries between ethical, unethical and forbidden become increasingly blurred. This is not a cleaner sport, it is a more conservative one. It is possible that fewer riders are doping, but it is also possible that the same number are, with more care to avoid detection. What is known is that far more doping exists than is detected, and now one cannot even used reduced racing speeds to argue that cycling is cleaner (the arguments the other way are equally strong).

USADA’s approach to the Armstrong case was wrong-headed

A number of commentators, whether professional journalists or interested bystanders have asked yet again why Armstrong should still be such a focus for anti-doping activity and debate – surely he is a scapegoat, and simply serves to absolve the future of cycling for its past sins? There is some truth in this, but there is more to the USADA case than Armstrong. Contrary to Bruyneels’ protestations, Armstrong and his co-defendants are not the only parties in professional cycling to be so ejected from the fold: the machinery of many other teams has been dismantled (one way or another) in the past when the evidence has presented itself. The crucial thing about the USADA case was that, regardless of inconsistencies on the length of some bans (both because of cooperation and legal arguments over the statute of limitations), staff still working, or potentially working with cyclists, were banned from doing so. Bruyneel would probably still be managing a cycling team now without this case, and the doctors and team-helpers banned alongside him would be also. There are certainly many still working in cycling who are equally culpable, but no-one has yet collated, presented and acted on the non-analytical evidence against them yet. Maybe their time will come, but I am convinced that by acting against the entourage and management of riders USADA were taking a useful step.

It’s all in the past

As cycling reaches new audiences it seems many want to collude in hiding its rich past of corruption and spectacle and pretend that we are in some Jerusalem of young, pure and ethical sport. I say Tramadol and Xenon to that, so there.

And that’s all folks, I’ve run out of ideas, and energy for writing this post properly – I would provide extensive reverences but no-one ever follows them, and I am just too tired!


Beyond truth and falsehood

September 13, 2013

Last night I watched Chris Horner win back the leader’s jersey in the Vuelta. I already knew it had happened, and there wasn’t much to see related to his performance, unlike his quite miraculous climbing the day before. Much has been written on Horner in the last few weeks. I won’t add to that. Instead, listen to A. L. Kennedy talking about lies and truth, in a short radio programme broadcast just after I watched Horner pulling on his red jersey:

Great Pretenders

I don’t care about the truth any more for itself. But I do want people to stop lying, cheating and manipulating. In sport there is a space within which artifice falls away. This space is now corrupted, as is its surrounding context. This situation is not new, but it has become heightened by our realisation that we are being lied to and yet do not really want the truth, or have any confidence that we can recognise it. Only the athlete knows the truth of their preparation, and even there self-deceit can blur reality. This is why anti-doping is always about ethics, and if based solely on detection and punishment will fail. I care about Warren Barguil, not Horner. If Barguil tested positive I would be saddened: another false dawn. If Horner tested positive I would just shrug: he’s a product of a different age.


The paradox of internal blood testing

March 8, 2013

One of the more mysterious aspects of recent revelations about the prevalence of oxygen vector doping is the role of internal testing of blood values. One might ask how it is possible such testing failed to identify the level of blood manipulation that is now becoming clear from evidence provided to the Puerto trial. The decision by Armstrong not to enter into an official internal testing programme with Catlin during his comeback is often seen as a signal that his interaction with Catlin was just a public relations game. Of course, Catlin is well aware how internal testing programmes can be perverted into early warning systems that actually facilitate doping, and still possesses in his infamous fridge the evidence that would demonstrate how dirty US athletics had become at at a time of intense internal testing. Of course, there is no paradox here, individuals and teams use blood testing to ensure they do not get caught by the official testers. Rasmussen’s recent interview on NOS (here in English with Dutch subtitles) confirms yet another purpose for such internal controls: to manipulate and maintain internal hierarchies within a team. As we know from the Hamilton book, and from Voet’s book on Festina, access to doping products is often controlled in such a way as to create a hierarchy of performance enhancement, with a group of favoured riders entitled to dope. Of course riders can choose to dope without the support of a team, but this presents logistical problems, and may be seen to be a deviation from a script. This where the Rasmussen interview becomes interesting. He notes that CSC stopped him from racing because his haematocrit was too high, and implies that one reason he switched to Rabobank was to be permitted to manipulate his blood as he saw fit. Indeed his difficulties at Rabobank revolve around discussion of how the team management retained control of blood doping to (probably) ensure that performances did not become too suspicious. In this way, internal testing becomes the enemy of anti-doping, not its friend.

Edited 09032013 to clarify testing of blood values, not for specific substances.


Change Cycling Now: observations

December 4, 2012

In response to a call from @cyclingfansvox, a twitter account set up to develop and channel the views of cycling fans, I made some brief comments on twitter about the output of the recent Change Cycling Now meeting in London. The document in question is downloadable as a PDF at the bottom of this post.

Here I expand on these comments, and welcome some constructive discussion. The thoughts are a bit raw and immediate, but that seems to be the spirit of the times.

Zero tolerance

The charter strongly opposes a zero tolerance, punitive approach to doping, and advocates a truth and reconciliation approach. I have argued here that anti-doping is not served by punitive scapegoating of individual riders, and the proposals might fit with this position. However, no amount of truth-telling by past perpetrators will improve detection of doping infractions unless it improves detection, education or deterrence. I am surprised that the charter does not explicitly link a measured approach to sanctions with steps towards improved detection, although one might argue that outsourcing anti-doping might improve detection if one believes that the UCI actively or passively fails to meet its obligations in this regard.

I have also argued that although disproportionate penalties for doping, especially where they dissuade openness, should be avoided, that the threat of criminal prosecution for doping or trafficking acts as a necessary component in deterrence, and that a criminal law enforcement approach has proved much more successful in bringing doping to light than traditional sporting law. The charter does not touch on these issues.

Independent approach to anti-doping

The approach to improving anti-doping proposed is a separation of investigation and enforcement from governance and promotion. This seems eminently sensible, and is in line with many national anti-doping approaches. However, given such a separation, it is interesting to consider where educational approaches might sit, or more importantly how to develop a joined up strategy to control doping that takes into account structural issues of reward. Points systems, remuneration policies, volume of racing and other drivers for doping would not be controlled by such an external body and there is a danger of the two entities running at loggerheads. The separation of USADA from USOC and USA Cycling has brought many benefits, but also much divided and arguably negative conflict.

Representation

The charter will stand or fall not just on its content but on perceptions of how well it represents the views of many stakeholders. It was pleasing to see two familiar stakeholders from the parallel world of twitter, and a mix of commercial, scientific, academic and sporting interests represented. It was also good to see two ex-riders, with rather different experiences of doping involved. However, the lack of current rider representation, and the bias towards riders who have doped was really puzzling, and will provide a serious barrier to any positive ideas being accepted by a crucial group. In relation to spectators too, neither of @velocast or @festinagirl (despite the initial press release) purported to represent fans: I would argue that for any real representation to happen a properly constituted fan body would need to first be created.

Focus on doping

As mentioned above, one cannot really tackle doping simply through testing and enforcement. Similarly, a focus on doping as opposed to taking a holistic approach to a sport might be hugely counterproductive. Moreover, this focus seems to assume that anti-doping is the major ill that faces competitive cycling. Many would disagree with this, perhaps selecting gender inequality or the professional focus. I would contend that to build a better sport attention to the whole journey from junior to masters competitor needs attention, across the sexes, amateur and professional.

Interests

A charter like this needs a clear and transparent declaration of interests from its authors. Here are mine: I hold no racing license and gain no financial or other benefit from cycling. Other members of my family race on an amateur basis. If you wish to take issue with my anonymity, then do read this and this. One of the fan delegates posted a useful positioning statement (the open letter below), but it is all too easy to portray some of the delegates as having revenge, or some other selfish motive behind their actions. I cannot judge this as I was not there, and cannot read minds, but this will always be a tricky issue to address.

open-letter (Scott O’Raw)

Charter-of-the-Willing (Cycling Change Now)


Welcoming doping into the home?

November 30, 2012

Paul Fournel is one of my favourite writers. ‘Need for the bike’ ranks alongside ‘The Rider’ as a paradigm of attentive, illuminating observation: that its topic (like that of Krabbé’s masterpiece) is cycling, is a bonus.
I wrote previously that although I respected and understood Fournel’s essay on doping in ‘Need’ I did not share his conclusions. He has a longer and more embedded understanding of the European tradition of competitive cycling than I, and a healthy dislike of false oppositions and hypocrisy. However, I fear the acceptance of doping as normative, however rational this might be: maybe my Anglo-Saxon lust for fairness and ‘truth’ is too deep, however hard I try to be more philosophical on such matters.
In the most recent edition of Rouleur (Dec. 2012: 86-7), Fournel responds predictably to recent revelations about Armstrong, and their place in our developing understand of doping in sport. He calls for us to ‘welcome’ doping, noting that perhaps only this will enable us to rationally control and assess its impact.
I am not yet ready to welcome doping. However, I welcome Fournel’s critique of the often hypocritical approach to anti-doping we are in danger of adopting. We have a choice: either sign up to legalisation and control, or properly fund and support a huge and multi-faceted prohibition, with the attendant complexities: ethical, legal, psychological, medical and scientific.


Secret Race vs. Human Race: it’s all about Tyler Hamilton

September 14, 2012

I wrote the other day about why we should resist the tendency to focus on individuals in efforts to combat sporting fraud, especially doping. Instead, I argued, we should focus on the institutions and values that facilitate and encourage such behaviour. Paradoxically, it is individual cases and the personalities of individuals that can be pivotal in catalysing such a change in focus. That is why we should applaud the actions of those that lift the veil, rather than scapegoat and vilify. Here, I want to explore some of the personal qualities that emerge in one such whistleblower.

Tyler Hamilton’s recent book with Daniel Coyle (The Secret Race) might easily be portrayed as a book about doping in general, and particularly as a book about the behaviour and personality of Lance Armstrong and his confederates. Whilst this is a reasonable and accurate response, I think it would downplay a more positive and constructive narrative about an individual who seems peculiarly adept at battling physical pain, but much less equipped to deal with the psychological pain of life and competition. It is this peculiar combination that makes the book much more interesting than pure exposé. If we are to understand doping, I would argue, understanding the mindset of those who are prepared to publicly discuss it is an important step to undertake. Read the rest of this entry »


Doping scandals: lessons learnt?

September 7, 2012

Ben Johnson, BALCO, Festina: sport often learns the wrong lessons from doping scandals. It learnt that coming clean about your doping when caught screws you and leaves others just as dirty to win; that if you have the right drugs and advice you will only get caught if someone gives you up; and that all sporting entities learn from a scandal is that a repetition must be avoided at all costs.
Read the rest of this entry »


Wiggins the Olympian?

July 9, 2012

Early yesterday I made the mistake of visiting the clinic. It turned out that almost everyone there thought Bradley Wiggins was a doper, either due to his team’s association with Geert Leinders (ex-Rabobank team doctor) or his supposedly extra-terrestrial power output during Stage 7. It was fairly depressing reading, which was shunted back into the positive by some more rational discussion on twitter about the leaders’ power outputs: the best estimates (based on Brajkovic who lost a bit of time to Wiggins) suggested to @scienceofsport that the leaders’ performance did not imply blood manipulation. Thus I felt happier, given that I would rather not see yet another Tour de France winner popped for doping. We have had too many of those in recent years (doping is not ancient history, contrary to the impression given by some professional cyclists).

This brief happiness lasted until it became clear that Wiggins seems to think doping is a problem created by fans and media, rather than riders and their teams. We do share a joint responsibility for engaging constructively with doping, but some of the most intelligent discussion of such matters occurs on twitter, on blogs, and even in the clinic (alongside ridiculous speculation). It disappoints me that Wiggins seemed so oblivious of the opportunity he had to respond constructively as the tour leader. Athletes (Olympians especially) have a responsibility to adhere to the underyling values of their sport, and indeed promote the, in order that they set an example. Sport is not just a job for those who agree to be part of an Olympic team:

Olympism is a philosophy of life, exalting and combining in a balanced whole the qualities of body, will and mind. Blending sport with culture and education, Olympism seeks to create a way of life based on the joy of effort, the educational value of good example, social responsibility and respect for universal fundamental ethical principles.

IOC (2011)

Those universal fundamental ethical principles underpin anti-doping. Cheating is against the rules of Olympic sport because it goes against the core values of Olympism. The stakes here are high, if we are to believe that sport is anything more than entertainment, spectacle and commerce. Jim Parry would like to suggest that Olympic sport can have such added value, providing a role model for behaviour, particularly for the young:

I believe that providing multicultural education in and for modern democracies is a new and urgent task, and one that must be made to work if we are to secure a workable political heritage for future generations. In the present global political context, this means promoting international understanding and mutual respect; and a commitment to the peaceful resolution of conflict. In the case of Olympism, I think that the formal values underpinning the rule structures of sport, acceptance of which by all participants is a pre-condition of the continuing existence of sporting competition, support at the educational and cultural levels such political efforts. Children who are brought into sporting practices, and who are aware of international competitions such as the Olympic Games and the World Cup, are thereby becoming aware of the possibilities of international co-operation, mutual respect, and mutual valuing.

Parry (2003)

Wiggins is an Olympic athlete, and should act in a way coherent with those values. If he wants us to believe, then he should be prepared to respond to what he sees as unfair criticism by reiterating his acceptance of the rules that govern the sport and acting as if he takes these rules seriously, not by swearing at anonymous critics who could simply be ignored or reacted to with factual rebuttal (the approach taken by Marco Pinotti).

They shoot horses: performance enhancement, risk-taking and the rage to master

March 20, 2012

In the last few days both the cycling and mainstream press have reported on the usage of presently undetectable performance enhancing drugs in cycling (see e.g., this article in de Telegraaf; this article on velonews.com). José Been wrote an excellent post on her blog tourdejose.com about two of these products, and following news of the arrest of Alberto Bèltran in El País, updated this with news that he had been caught with both AICAR and TB-500, making the link back to the arrest of Wim Vansevenant on the eve of last year’s Tour de France. Here I consider the implications of turning to such ‘new’ drugs for cycling in particular and sport in general. Read the rest of this entry »


Follow

Get every new post delivered to your Inbox.

Join 1,193 other followers