06 August 2010

Michael Ashenden interview regarding Lance Armstrong

I just finished reading this interview and thought it was hugely interesting:

http://nyvelocity.com/content/interviews/2009/michael-ashenden

Personally I don't think it presents any new evidence one way or the other - especially since it's from 2009 - but it's my perception that this information has not been readily available in the media and it was 'new' to me. Now of course it's making the rounds on the Internet but as usual, Martin is Johnny Come lately to all this...

What I like is that it not only discusses everyone's favorite cancer survivor and product spokesperson but it also is very educational when it comes to drug tests, power, muscle efficiency, what makes a statistically sound study, etc.

I keep asking myself when this house of cards called the LA Promotion Machine (including Johan Bruyneel and Nike and Trek and Chris Carmichael and other US pro cyclists like George Hincapie who are from the same era and you name it) will come tumbling down. Just one month ago before the start of the Tour de France I would have said it won’t be for at least two years. Now after hearing what Floyd Landis had to say and hearing about the pending Federal investigation I think it will be much sooner.

ASIDE – for those of you that recall what Frankie Andreu and his wife had to say ages ago, this is not news at all.

Of course there is no denying that Lance has the best team on his side. He has the best coaches, the best sponsors, the best specialists to assist with aerodynamics and of course he has the best legal help that money can buy. Because of this legal team and because so much of this stuff is decided in the court of public opinion I'm still not convinced that justice will ever be served.

And check the comments, talk about polarized...

Just in case the link to the interview dies, here is the full transcript below.

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Dr. Michael Ashenden began his career as an exercise physiologist with the Australian Institute of Sport. After assisting in the development of an EPO test for the Sydney Olympic Games, he left the AIS to focus on battling blood doping. In 2005, Dr. Ashenden was among of group of scientists who questioned the validity of a physiological study on Lance Armstrong, a dispute that led him to serve as an expert witness in an arbitration case involving Armstrong and a bonus payment for winning the Tour. Dr. Ashenden kindly agreed to speak with us and shed some new light on that controversy. He also helped us analyze the 6 positives from Armstrong's '99 Tour samples with a level of detail never before made public.

Personal background, the 2000 Olympics, EPO testing

ashenden

Andy Shen: Can we start with a little background on you, starting with the Australian Institute of Sport? I guess at that time you were doing some work on blood doping, but you were also doing some work on performance enhancement.

Michael Ashenden: I was employed as an exercise physiologist with the AIS, and my job was to do physiological testing on the athletes, for example, to give the coaches feedback and assistance with their training programs. At the same time I was doing my PhD thesis that was studying what happened to athletes' blood when they were exposed to simulated altitude, hypoxic tents and such which have since become popular.

And that dovetailed nicely with research at the time that was looking for indirect markers of EPO, because not coincidentally I guess, the changes in the blood that we see with EPO were sometimes similar to changes you'd see at altitude, though dramatically on different scales. But it was easy for me to transfer my research and my knowledge there over to this EPO field and I guess that's where I began my career in anti doping, being part of the team in Australia who were working on what's since been called the Sydney Blood Model. And from there I left the institute and I've been working as a freelance researcher not just in EPO doping but other kinds of blood doping. Blood transfusions, blood substitutes, pretty much any avenue I think an athlete might be tempted to abuse, we try to conduct research in those areas.

AS: The work you did for the Sydney Olympics, that was in 2000?

MA: Yeah, at that time there was no test at all for EPO, and the UCI was using a 50% hematocrit rule to stop athletes from competing, but it couldn't go any further than stopping them competing. So, there was a group in France that was researching what's since become known as the urine test for EPO, and we collaborated with them, we shared samples with them, to help the research move forward. But we took a different strategy, we looked for indirect evidence.

We were looking for changes in the blood that were not only apparent in the period when the athlete was using EPO, and that's the period when EPO is still in the urine, but blood remains disturbed for several weeks after you stop taking EPO as well. The urine test can't help you there, but the blood test still gives you a signature, depending on how much EPO you took, a couple of weeks after you stop injecting.

AS: The EPO test was implemented for the 2000 Olympics?

MA: At the Sydney Olympics they had the two part test. There was an initial blood screening, and if those results exceeded the threshold that were put in place, then the urine was analyzed. And the criteria back then was that you had to fail both the blood and the urine test in order to be found guilty of having used EPO.

Since that time WADA has revised the rule and now you only have to fail the urine test. Whether your blood fails criteria or not is not taken into account in today's test.

AS: So just to be clear, the urine test looks for the actual presence of synthetic EPO, but EPO leaves your system in two or three days?

MA: EPO is a hormone, it's a very small molecule, and it's present in very very low concentrations in the bloodstream, even lower concentrations in urine. And the half life of EPO is something in the realm of eight to twelve hours, so one day after you've had an injection the levels are dramatically lower. Usually three or four days after you've had an injection all traces of EPO have left the circulation or at least aren't present at a high enough level for the urine test to be a definitive piece of evidence that EPO is being used.

AS: When you test positive in a urine test, it's not a yes or no thing, it's a percentage and a threshold, is that correct?

MA: I think that's arguable. It's a test that discriminates, it puts in different positions on the gel, synthetic EPO and natural EPO. Now, there is no confusion when you see it on the gel, when there's synthetic EPO in the sample. It's simply in a different position to where the natural EPO occurs.

So when you say it's not yes or no, you can see visually if there is synthetic EPO in the gel. They build in some allowance, some tolerance, the positivity criteria that are in place today follows specific rules. And even though there's EPO in the gel, unless it fails those specific criteria a sanction isn't imposed.

AS: Ok, so in other words, the tester will know you're using it, but you won't be busted for it if you're below a certain number.

MA: Yeah, and there are situations like that floating about today. Where it's clearly a pattern that an athlete has been using synthetic EPO, but for different reasons the pattern doesn't follow a specific criteria. So the answer is, yes, obviously they're using EPO, but they weren't sanctioned because the samples didn't fail a very specific criteria that were applied.

AS: And this number is a percentage of isoforms?

MA: That was the first generation of tests. Since then the positivity criteria has been modified, and now it looks at several different aspects, not just the percentage of basic isoforms.

EPO use in 1999

AS: I want to go to the '99 Tour samples. Just to set the scene, in '99 there wasn't a test in place for EPO, and Frankie Andreu told us there was no anxiety about using it, because as long as you made sure your hematocrit was below 50% you knew nothing could happen to you. Would it be fair to say that at that time it was pretty easy for cyclists to beat the test, or use EPO with impunity?

MA: Well, I wouldn't say that it was easy for them to beat the test, because there was no test. Simple as that. There was no way, before the Sydney Olympics in 2000, where an athlete could be found guilty of using EPO, because there was no test in play. There's no reason for an athlete to be careful using something for which they can't be caught.

AS: As long as they kept their hematocrit below 50.

MA: And that's a relatively easy thing to accomplish. I mean, you can either use careful adjustments of your dosage, or you can use saline to dilute the blood. It's a relatively simple and fast procedure to bring your hematocrit below 50.

AS: Yeah, in fact, from the time you're notified of a test you can actually dilute your blood fast enough to beat the test.

MA: Yeah, it was quite disturbing for me to be told that right up until perhaps 2004, the UCI weren't actually chaperoning riders between the finish line and doping control. So not only was there an opportunity for them to dilute their blood before a blood test in the morning, there was also a very real opportunity for them to manipulate or mask their urine before they provided their doping control sample. That wasn't important pre 2000 because there was no urine test for EPO, but after 2000 there was still, to me, unacceptably large loopholes for an athlete, even if they've been using EPO, to still escape detection. Particularly by masking their urine, in between the time they crossed the finish line and dope control.

'99 Tour urine samples re-tested in '05

AS: Let's go back to the '99 urine samples, these were B samples which were preserved. Was it for academic reasons that they re-tested, to get a sense of how things were at the time?

MA: I mentioned earlier there'd been revisions over time of what the positivity criteria were. Initially it was 80% basic isoforms. The research that was conducted with these samples was informing them of whether new criteria they were considering applying would have been effective in catching athletes in previous events.

The only kind of samples that are useful in that context are samples that have got EPO in them, 'cause then you could say by criteria A you'd fail, but by criteria B you didn't fail, and by criteria C we saw nothing at all. And that was the purpose of the Paris investigation - to go back, to look at samples, and to see how the different criteria applied. And it was, I don't think it was cynical, it was realistic, they realized that the most likely samples where they would find EPO were samples collected before the EPO test was introduced. And that was the '99 Tour de France.

Lance Armstrong's '99 samples test positive

AS: So out of the 87 usable samples that they gathered, they got 13 positives and 6 of them belonged to Lance Armstrong.

MA: Depending on which criteria you applied. Yes, six of them failed the definitive criteria. There were another two samples in fact where the EPO was visually there in the gel. You could see it was there, but for one reason or another, the percentage isoforms weren't calculated, or had to be re-analyzed, or it was a little bit too faint to get a definitive result. Yes, there were six samples with EPO in it, and there were another two samples where it was pretty plain to a trained observer that there was synthetic EPO in those as well.

AS: You were able to analyze the results, correct?

MA: I interpreted the results. They assessed each sample according the different criteria, and those were the results that we were given.

AS: I found it kinda interesting, we've talked before this, you found some very interesting things about those results that really were not widely publicized, the way the percentages fluctuated.

MA: One of the things, I guess there's been misinformation in this particular area - is that the samples weren't analyzed properly, that they were analyzed using a different protocol than what was used in proper dope controls - and that's just not correct. Obviously in research where the data you come up with is going to govern how you do testing in the future, you're exceptionally careful with these measurements. You want to make sure that you don't make any mistakes. And you want to make sure that you, for example, weren't looking at urine that has been contaminated with bacteria, or isn't what we call unstable urine, where sometimes the bands shift not because of EPO use, but because of some other factors. So all of these checks and cross checks were put in place with these samples, so the data is valid. The laboratory, I've checked with the people who did the analysis, and I very carefully went through it with them. They're absolutely 100% sure that these results are valid.

And as far as the fluctuations you speak of, when we took the samples' dates, and matched them with the percentage of isoforms, and overlaid that with the performances during the Tour de France, then a clear pattern begins to emerge. You can see that on some days there's a preponderance of EPO in the urine sample, perhaps on the next day they come down a little bit, then they come back up, which is suggesting you've taken another EPO injection.

You don't have EPO every single day. You might take it every two or three days. So your values go up or down according to when you took those injections and when those urine samples were taken. Now, you overlay all of those data together and you can begin to see a pattern that's consistent with EPO use.

Stage Vial # Visual Interpretation % Isoforms Stage Description
Prologue 160297 + 100  
1 157372 + 89.7  
7-Feb       out of lead, not tested
8 186584 + to be reanalyzed Metz TT
Rest Day        
9 185557 + 96.6 Sestriere
10 185479 + 88.7 L'Alpe d'Huez
11 185476   sample missing  
12 185475 + 95.2  
13 185895 + weak intensity, no % recorded  
14 186397 + 89.4  
Rest Day        
15-20     undetectable, insufficient EPO in urine  

AS: The prologue had the highest number, 100% if I remember correctly, and the next day it goes down a bit. Same thing before the first mountain stage, etc.

MA: And the unusual thing about the prologue sample is that the prologue was run in the morning, and the sample was collected at 9:45 am. Now, every other sample during the Tour de France is collected in the afternoon, after the stage is finished. This sample was collected very early in the morning, and there was 100% basic isoforms, which is saying that 100% of the EPO that was showing up in the gel was synthetic EPO. There was no endogenous EPO visual in the gel.

The possibility of tampering

AS: I guess I should set the background a little bit more now. This study was done for research purposes so the urine was marked with code numbers and there was no way for the testers to know who the samples belong to. It was only through some subterfuge by some French reporters that it was revealed that the six positives belonged to Armstrong.

MA: Well, again, there's been a lot of disinformation about this. The laboratory absolutely had no way of knowing athlete identity from the sample they're given. They have a number on them, but that's never linked to an athlete's name. The only group that had both the number and the athlete's name is the federation, in this case it was the UCI.

The UCI had those documents, and an investigative journalist, Damien Ressiot from l'Equipe, went to the UCI and said, "Can I have copies of Lance Armstrong's doping control forms from the '99 Tour?" Now, the UCI had to go to Lance Armstrong and ask his permission, which he gave them. Now, Lance Armstrong gave permission to the UCI to give these doping control forms to Damien Ressiot. Damien Ressiot took those forms, which have the athlete's name, obviously, and the sample number, so he matched the sample number with the results from the laboratory that had the sample number and the percentage of isoforms. And in that way he linked the percentage of isoforms with the number, the athlete's name, and in that way identified them as Lance Armstrong.

AS: Right. So the lab is carrying out these tests blindly, and you showed me this statistical study of the odds of them tampering and successfully framing Armstrong, and it was 1 in 300.

MA: There was only two conceivable ways that synthetic EPO could've gotten into those samples. One, is that Lance Armstrong used EPO during the '99 Tour, and we've since found out that there were teammates from US Postal in that '99 Tour that have since admitted using EPO while riding for US Postal in that Tour.

The other way it could've got in the urine was if, as Lance Armstrong seems to believe, the laboratory spiked those samples. Now, that's an extraordinary claim, and there's never ever been any evidence the laboratory has ever spiked an athlete's sample, even during the Cold War, where you would've thought there was a real political motive to frame an athlete from a different country. There's never been any suggestion that it happened.

However, Lance Armstrong made that claim. Now, it's very easy to go back and assess the possibility of that scenario. We know the laboratory could not have known which samples belonged to Lance Armstrong. And we also know from the results, how many of Lance Armstrong's samples had EPO in them, and when during the race it occurred. Now the odds of the laboratory randomly selecting Lance Armstrong's samples out of those 87 samples, and let's just do it conservatively, just 6 times, 6 times they got his samples correct out of 87 possible tubes, the odds of that occurring are at least 1 in 300.

So we come back to the original scenario. Either Lance Armstrong used EPO during the Tour, or the laboratory spiked his samples, and we know the probability of that happening was at least 1 in 300.

(I needed to reassure myself that tampering was inconceivable, so I did some follow up with Dr. Ashenden. Click here if you're interested in what it would've taken to spike these samples.)

An irrefutable profile

AS: And of course, if you take it to the next level, let's say, not only will they have to spike it, they have to spike it in a way that when positive samples are on concurrent days, the second day has to be a lower percentage. And not only that, when they spike the prologue sample they have to spike it really high because it was after a short effort and it was tested earlier in the day. Now if you take those factors into consideration the odds become astronomical, don't they?

MA: I honestly can't conceive how you could possibly do that. I don't understand how you could inject enough EPO so that the percentage was slightly lower on the next day, it just beggars belief that you could adjust the amount of EPO you put in a sample by such a miniscule amount. And to be quite frank, it doesn't hold up to scientific scrutiny, it's a fantastic claim in the literal sense of the word, it's not backed up by a shred of evidence at all, and I think it needs to be taken on that merit.

AS: So outside of deliberate tampering, is there any way contamination, degradation, is there any way synthetic EPO appears in urine because of contamination, degradation, bad handling, bad refrigeration, anything?

MA: The short answer is no but I have to clarify that. There is evidence that sometimes if a urine sample is stored unfrozen, there can be some contamination of the sample that shifts the band up towards the area we associate with synthetic EPO. Now, it can still be distinguished but it makes it more difficult. There is a test and this is in place throughout laboratories today, they can determine whether or not the sample has that unstable profile.

That possibility was excluded in all of these samples. So yes, it's conceivable that contamination can shift the band, but it didn't happen in this case, that was definitively excluded. There is no way that synthetic EPO can suddenly appear. It can disappear, you could conceivably have degradation where synthetic EPO could break down, it's not likely but it's conceivable. But in that scenario you've got synthetic EPO disappearing, not appearing. It's breaking a pretty fundamental law of physics to say you can generate a molecule of EPO from nothing.

AS: So based on that, you can definitively say that Lance Armstrong used EPO in the '99 Tour. No doubt in your mind.

MA: There is no doubt in my mind these samples contain synthetic EPO, they belong to Lance Armstrong, and there's no conceivable way that I can see that a lab could've spiked them in a way that the data has presented itself. So there is no doubt in my mind he took EPO during the '99 Tour.

The rest of the '99 samples

AS: The other thing that struck me about these results, which I was surprised never came up before, was that if you take away those 6 positives, you have 7 remaining positives out of 81 samples. That's 8.6%. Does that say to you that at that time the peloton was relatively clean?

MA: Yeah, it's an interesting observation, 'cause you cast back to the '98 Tour, obviously it was a debacle. And, I've heard anecdotal or off the cuff remarks, that '99 was a new beginning. It had gotten as bad as it could possibly get, or so we would've thought, and '99 was, "Ok, let's start again, we've really got to make an effort to be clean this year."

Well, obviously, based on Lance Armstrong's results, he wasn't racing clean. But for the rest of the samples collected during the Tour, relatively speaking there wasn't a very high prevalence of EPO use in the rest of the peloton, at least in the peloton that was tested, which was your top 3 place getters, for example.

The prologue was interesting. First race of the event, every one of those samples had EPO in them. So it seems a little odd, the first day of the next year's race, and all of your place getters have got EPO in their urine. On the one hand, yes, it seemed less prevalent than you would've otherwise thought, but on the other there's still evidence there was doping in the peloton. Not just by Lance Armstrong.

AS: I guess it's possible that some guys were injecting during the Tour, and some had an EPO program leading up to the Tour and counted on the effects to remain with them?

MA: It's conceivable. It's widely known that you don't have to be using EPO to get the benefits. You can have a treatment regime that could last as little as ten days, and the benefits are substantial and they'll stay with you for four weeks afterwards. And certainly for the Tour, which is three weeks. So, you don't have to use EPO during the Tour to get the benefits.

AS: I just want to go back to the percentage. Obviously, stage winners are always tested, and there were, I believe Cipollini won four, Steels won three, Etxebarria won two, so, not that I'm accusing them, but there's a chance that some of these positives are from the same person, so there's a chance that the number of people positive is even lower than 8%. And not only that, a great deal of these samples are from stage winners, so they're the stronger riders. So the samples are a skewed sampling of the entire peloton.

MA: Yeah, that's correct.

AS: So you could say as a whole it might've been 8% or less.

MA: And there is no way to identify who those other samples belong to without getting access to the medical records and matching the numbers to their names. So, I've read reports, but I've never seen documented evidence to link names to numbers.

AS: It's interesting because when I spoke with Paul Kimmage he made a pretty big deal about that year's Tour, that it was supposed to be this Tour of redemption, and his point was that Armstrong came along and brought things back to the old ways. These results lend that belief a little bit of credence, don't they?

MA: I think there's a couple of things that strike me as well. Yes, these results are consistent with that argument. The other is that we know how Armstrong performed before the '99 Tour. '93, '94, '95, '96. And look, a couple of those races he couldn't even finish, another race I think he's an hour and a half behind. Specifically in the time trial he was dropping minutes to the other competitors.

Now compare that with '99, and it's a helluva transformation. Instead of dropping off and not being competitive, he was actually dropping the rest of the peloton off. So something dramatically changed in relation to Armstrong versus the rest of the peloton across that period of time. That's unarguable.

There's, as we've been talking about, pretty unequivocal evidence, well, it is unequivocal evidence, that he was using EPO during the '99 Tour. Now, that would go a long way to explaining that reversal in competitiveness in Armstrong v. the peloton.

Ed Coyle publishes a study on Armstrong

AS: Actually, that's the perfect segue for us to start talking about Ed Coyle a little bit. Ed Coyle wrote a study in 2005 about the work he did with Armstrong from '92 to '99, where he claimed that he was able to improve his watts per kilo 18%. Armstrong himself holds this study up as proof that he didn't need dope to win the Tour. There were two ways Coyle went about it. One, Armstrong's efficiency improved, and two, his weight was reduced. How did you become aware of this paper?

MA: I guess I need to put it in a little bit of context. Muscle efficiency is sort of like a holy grail in physiology. To put it in context, a 1% improvement in efficiency has been calculated with various modeling techniques to give you about a one minute improvement in a 40k time trial. So an 8% improvement in efficiency is simply unheard of. It has never been measured before, and so naturally, when Ed Coyle published a paper reporting that, there was an enormous amount of interest. Not just in the lay media, but in scientific circles as well, because lots and lots of people have tried to see if they could change cycling efficiency with different training protocols, it has never been found to change.

And so when you report that not only has it changed, it changed by 8%, then obviously that seems a very unusual finding. As scientists, the first thing you want to do is say, "I want to read the paper, I want to satisfy myself with the methodology that he used, because, gee, this seems like a strange result."

AS: Let's just define the term real quickly, cycling efficiency. The idea is that if you're riding at 400 watts, your body is actually producing much more energy than that, and the efficiency is the percentage of cycling power vs. total power?

MA: Yeah, in very simple terms, it's how much of the energy production in your muscles actually go into the pedals and gives you propulsive force.

AS: And overall energy is measured by how much oxygen you're burning?

MA: Yeah, it's a laboratory test where the subject is put on an ergometer, you measure very carefully how much oxygen the body is using, and that will tell you how much energy is being burned, if you like, in very crude terms. And then you look at the ergometer, and you measure very carefully how much energy the athlete is producing, and the ratio of those two after some adjustments give you the index of efficiency.

So, how much oxygen is he using, versus how much energy is he putting into the bike gives you that index of efficiency.

AS: So Coyle was claiming that for a given oxygen consumption, Armstrong was producing more watts because he was making himself more efficient through training.

MA: That's right. The claim was that because Armstrong had been training for three to six hours on his bike over a period of years, that probably altered his muscle composition, which led him to having a greater efficiency. Now, the only, the glaring oversight there, is that Lance Armstrong is NOT the only cyclist that trains for three to six hours on his bike each day, it's pretty much routine for a professional cyclist.

So, many other professionals have been measured after they've done this same sort of training, but none of them have shown a change in efficiency, which immediately brings into question the basis of Coyle's claim.

And he speculates that this was due to his unique ability to convert his fast twitch muscles to slow twitch muscles.

Again, there was no data to substantiate it. It was his speculation, attempting to explain what he had measured. Again, it just comes down to a simple case of, well, ok, if that was the underlying biological reason, then you'd expect to see it happen over and over again. There's nothing, despite what other people want to believe, there's nothing unique about Lance Armstrong. He's a human being, and he responds as other human beings do to training. And no one else has ever measured those changes that Coyle speculated might've happened in Armstrong.

AS: As a matter of fact, you could take a biopsy of his muscles and analyze it, but he never did.

MA: To put it in context, this wasn't a carefully planned study. This was an opportunistic approach where, the students in the lab related to us, it was simply a matter of Lance Armstrong swinging by occasionally, and Ed Coyle would test him almost as a favor to him, to give him some data. If he came into the lab, great. If he didn't, then there was no data.

And I think that's borne out. If you look at the timing of when these test sessions took place, there really isn't any coherent pattern. For example, if you really wanted to show that your cycling efficiency had increased leading up to a Tour de France, then you want to measure him immediately before, or immediately after the Tour. You don't wait four or five months, like Coyle did in '99, when he's stopped training and was almost beginning the next season.

So, it wasn't carefully planned, the timing of the test sessions were opportunistic rather than carefully thought through.

AS: Let's go in chronological order. You became of aware of this study, and then did you and some of your colleagues lodge a complaint with the University of Texas?

MA: The way it happened is, obviously when the article came out, it spiked a lot of interest and discussion in the scientific community. And the way that scientists address those issues is to write letters to the journal that published the article. Essentially in the letter, you're raising some questions, and then the author is given an opportunity to respond. So both your concerns and his response are published side by side to inform of the rest of the scientific community so they can judge for themselves - well I agree with that, or I don't agree with that.

So that's the first thing that happened, there were two letters published in the journal that questioned very specific aspects of the study. One of those aspects was which ergometer did Coyle use to measure Armstrong's power during those seven years. Now, the reason that's so critical is you HAVE to use the same ergometer very carefully calibrated to make sure that when you measure, say, 300 watts in 1992, that seven years later in 1999, if the ergometer reads 300 watts, you want to be sure that that's correct, and not just an artifact of the ergometer that you're using is different, or uncalibrated, or whatever.

So, the first question related to that, because we had experience with these longitudinal studies, they're exceptionally difficult to carry out successfully. The first question that we had was, "Did you use the same ergometer to measure power output?"

And categorically Coyle responded, "Yes I did. The same ergometer was used for all tests." And, we had to take that at face value. When you question a scientist, they publish their response, and you are obliged to accept whatever they say. So we pretty much had to accept that. We still had reservations, but that was as much as we could know.

Then interestingly, the paper itself became involved in an arbitration hearing where I was asked to serve as an expert witness and interpret this paper for the hearing. In that process I did some background checking to verify to myself what was happening and could this data be relied on. And I was very surprised when we were given a photograph showing Lance Armstrong in the first test session on an ergometer that was definitely not the ergometer that Coyle claims he tested him on.

It was a very disturbing revelation and it was purely a fluke occurrence, where the journalist had been in the laboratory, was taking photos for this journal article, and happened to take a photo while Armstrong was being tested. So we had that reservation and several others that we still felt uneasy about, and we elected to take those directly to Ed Coyle confidentially. We spelled out our concerns, and we said, "Professor Coyle, with the greatest respect, we really don't believe this paper is worthy of publication, would you please retract it?"

And his response was characteristically vehement, and adamant, that he would not retract the paper. And so, from that point we had no option but to seek some other way of getting what we felt was a scientific error corrected. And the next step up was to go to the journal themselves, and say, "Look, these are our concerns, what do you propose we do about it?"

And it came after a lengthy round of discussions, that the journal weren't going to do anything until we made a formal application to the university of scientific misconduct, and that's a very serious step, when you actually go to the scientist's institution and formally claim that he has conducted himself in an inappropriate way. And you're formally asking the university to take action. So those were the steps that began with just an initial "Gee, this paper seems unusual" and gradually became more and more disturbing as more evidence came to light, and eventually resulted in lodging this allegation of misconduct.

Previously undisclosed inconsistencies

AS: Of all his errors, I think only two were allowed to be made public. One was the use of different ergometers, and the other was this misapplication for the formula for gross efficiency and delta efficiency. And I have to confess, I've read about it a lot and I cannot for the life of me understand it. Something about the y-intercept and pushing a line through the origin that shouldn't have gone through the origin because I guess if that line goes through the origin you're probably dead, 'cause your body's not doing anything.

And I think that very esoteric issue, the misapplication of an equation, made it hazy for a lot of people. But in fact, there were a lot more complaints of Coyle than those two issues, weren't there?

MA: Let me clarify the use of that equation. You're right, essentially forcing the line through the 0 intercept, it is inferring there is no other metabolic activity in the body. That the energy your body uses simply to breathe, to sit upright on the ergometer, there's just 0 energy being used. Obviously that's incorrect. Coyle's own publications, previous to this one, he argued that you cannot use gross efficiency, which is ignoring this metabolic energy consumption. The significance of that slope and that intercept is "are you making allowance for this other metabolic activity?"

Now, in his publication, he led us to believe he used the correct equation. However, once we launched this allegation of misconduct, again he's given the opportunity to defend himself. His defense was to produce one of the raw data sheets from the first test session to validate that he has done the testing in the way that he says that he has in the publication.

Now, we were given access to that data file, and immediately we went through it and it seemed very odd. The most striking thing was that in the publication he said that he used five minute workloads, I think there was five of them. And in the raw data that we saw, there weren't five workloads, there was only four workloads and some of them were two minutes long. Completely contradicting what he'd written in the publication.

The other thing that became apparent when we looked a little further, was that if he applied the equation that he said he had, he would've come up with a very different answer. In fact, the correct equation applied to that data gave an efficiency that was the same or fractionally higher, even, than the last result Armstrong obtained in '99. Which is to say his efficiency didn't change at all if you applied the correct equation.

Now, we weren't privy to that information until after we made that allegation of scientific misconduct. So every time we peeled off another layer, even more disturbing evidence came to light. The university said that the evidence wasn't sufficient to impose an allegation of misconduct, but they did recognize that there were some anomalies, they did recommend that these needed to be brought to the attention of the scientific community. It was very much steering us back to the journal and saying, "You're gonna have to write another letter."

So in that second letter we wanted to address everything that we found. All the different equations, the different workloads, the different ergometers, the fact that he hadn't controlled for prior exercise, all these sorts of things. But we were given a very strict directive by the journal, that we could only talk about this delta efficiency equation, and we weren't allowed to discuss, for example, that Professor Coyle had refused to give us any more data to back up the other test sessions. His claim was that he'd lost the data.

So the letter seemed, probably, very dry, perhaps even a bit paper thin. But underneath that letter there was a lot more issues that we knew about that we weren't allowed to publish.

AS: And of course you said his '92 numbers were off, and you weren't able to properly compare it to his '99 numbers because he wouldn't give you the rest of his raw data.

MA: That was one of the most disturbing things to me personally. I've always had it hammered into me during my studies that you have to keep all of your raw data in case another scientist brings it into question. You can always fall back on your data and say, "Look, you go do the calculations yourself and satisfy yourself that what I've written and what I've published is correct."

And it's pretty much the first thing that you learn as a student: keep your data. Now, contrary to that, Professor Coyle claims that this data he collected on the person he thinks is the most gifted endurance athlete on the planet, I mean, he did win the Tour de France seven times in a row, he's a unique case study in every sense of the word. And yet, Professor Coyle would have us believe he lost the data that he collected on this athlete.

And bear in mind, he published this study in 2005. This is well after Armstrong had clearly dominated the Tour de France, and the last collection date Professor Coyle recorded was in '99. So it wasn't as if he could argue, "Well, I didn't know he was going to be a big star, I sorta just chucked the data away." In 2005 he went back, published the data from '92 through '99, and somehow between 2005 and when we made this allegation in 2007 he lost the data. Now I find that incredible.

AS: Now would be a good time to throw in the stipulation. You had collaborators when you lodged your complaints. Now we want to make clear that you're only speaking for yourself, especially when you're talking about Armstrong. Their issue is purely with science and with Coyle.

MA: Yeah there's two layers to this if you like. I have an interest in the Coyle paper primarily because I was asked as an expert witness in the arbitration hearing to interpret it and to provide my opinion to the hearing. Now, that is my interest.

In contrast to that, my colleagues, who were co-authors on the letters to the journal, their primary concern is the scientific validity of the study. They're still working in the field of physiology, and they're very disturbed that data is in the public domain which we believe is simply false, it's incorrect. And they wanted to correct the data from a scientific integrity viewpoint, my personal interest stems primarily from the fact that the paper was introduced into this hearing, was used to defend against allegations that Armstrong had used doping. And therefore my interest is different from that of my co authors.

A laundry list of errors

AS: Let's just do a rundown of the other issues raised in this formal complaint. Prior exercise was not controlled for, so some days he might've showed up to the lab after doing a training ride. You're not supposed to do that, are you, when you're doing testing?

MA: Everyone realizes that if you've just come off a one hour bike ride, you can feel that your metabolism is kicking up, your body is hot. Your efficiency measures then will be different. Coincidentally, the kind of differences you see associated with exercise are pretty much the same as the differences we see over this seven year period. The potential for exercising before your test is very important, it can completely cloud your results.

Again, relying on more than one student, there were several students who contend this, Armstrong for example on one day had just been riding up in the mountains with one of his professional teammates, came into the laboratory and did an efficiency test. Now, from a scientific perspective that's simply unacceptable. You just cannot do that. Efficiency is very difficult to measure at the best of times, and you go to every length that you can to control all the things you're able to in the hope that your results are as accurate as you can get. And obviously one of the most important things is you make sure your athlete comes to the laboratory rested every time they're tested. And that simply didn't happen with these results.

AS: And the other side of this efficiency calculation was that he got 8% more efficient, and because of his weight loss, if you add those two things together, his watts per kilo improved 18%. But he never did directly weigh Armstrong for some of these calculations, did he?

MA: The 18% improvement was half attributable to the increase in efficiency, and half attributable to a decrease in body weight. As you say the power per kilogram increased 18%. So half of it was the power, half was the kilograms. Again, it's very basic science that if you are going to include a value that is so fundamental to the result, such as body weight, you measure it.

Now essentially, and Coyle admits this in the paper, he just guessed. He said, "Well, Lance Armstrong told me that he was 72 kg, so that's the body weight I'm going to divide these power measures by." Now, obviously, when you take your first measure and you say I'm going to use 79 kg here, and then you take the last one and you say I'm going to use 72 kg there, automatically you have an enormous difference.

And instead of that being a real difference, it was simply Coyle's guess at what his body weight was. Now, interestingly enough, during the proceedings, not just the allegation of misconduct but in the arbitration hearing itself, when people are sworn under oath, even Lance Armstrong himself acknowledged that his body weight had never dropped to 72 kg. So it was factually wrong.

So half of the 18% improvement attributable to a change in body weight is again demonstrably false. It's just not real. It's incredibly sloppy science to use a value that you just guessed rather than measured. It's simply unjustifiable in my view.

AS: I personally find it a very dangerous claim because just last week it appeared in a credible paper, the Washington Post. For a finding that's very shaky, for casual fans, it might be a number they actually believe.

MA: The Journal of Applied Physiology, which published the paper, it's not exactly a coffee table magazine. It's a fairly dry, scientific journal. It's highly regarded in physiological circles, but it doesn't get much publicity elsewhere. This article received enormous media attention. Ed Coyle essentially went on a lecture tour publicizing it. I think, because of that public and media interest, it became the most read journal article at the time. So it did receive enormous coverage, and the fears we have as scientists is that people unfamiliar with the area would accept it at face value. And that's why we felt so compelled to correct the scientific record so that it wasn't perpetrated as, "Gee, cycling efficiency can change by that much, and all you need to do is train six hours a day!" It's just not right, and so we need to correct that.

AS: Is there any evidence of fast twitch muscles being converted to slow twitch muscles?

MA: Sure, sure, that happens. All you need to do is collect muscle biopsies, and there are those transitions. But the scale of them is nowhere near sufficient to give this 8% improvement in efficiency. That's the thing that's never been measured before. It's a difficult to understand area inasmuch as to say that everything Ed Coyle speculates on has got a scientific basis. The problem is that it's just never happened in cycling. For example, in runners, there's been documented improvements in running efficiency, and that can happen. It's all got to do with elastic energy storage in tendons and things like that. But there is no elastic component in cycling, and as I've said before, lots of researchers from all around the world have tried to measure it and find the difference, and no one ever has.

AS: In fact he's quoted in a National Geographic article as saying that this has never been documented in any other human. To me, that's an anti-scientific statement, it's like saying he's magic.

MA: That's odd because in his testimony at the arbitration hearing he brought the evidence of a runner improving his efficiency to the table. I don't dispute efficiency can change in other sports. It doesn't change in cycling.

AS: Have you ever observed an 18% improvement in a cyclist after he has turned pro and been a World Champion, competed at a very high level. Is an 18% improvement plausible, have you ever observed it?

MA: The answer is no, but you don't need to go that far down. The data recording the 18% improvement are wrong. There's no need to second guess or say, "Well, could it have happened?" The data is wrong.

The Cloak of Secrecy

AS: The other thing that surprised me is this idea of cancer taking away 15 pounds, it's another one of these publicly held beliefs that became so ingrained, and it was surprising to find that he didn't lose any weight post cancer. And not only that, he's listed as 5' 9", 5' 10", but we know from speaking to his teammates he's more like 5' 5", 5' 6". I guess you're on the metric system...

MA: You cast yourself back to 2005, and I'm very acutely aware of this, there was a wall that came up against me immediately as I was trying to interpret the background data on Armstrong. There virtually was none. Before the Ed Coyle paper no one really knew for sure anything about Armstrong. Not his VO2Max, not his power output, we didn't even know how much he weighed. All you could rely on was very loose, for example in the article that was published after his first test session in Coyle's lab when the photographs were taken, they report him as being 77, 78 kilos. You contrast that with the data in Coyle's paper, and he shows that the lowest body weight was 75 kilos in '93, but in November after his first Tour victory, it was 79 kilos.

Now, Coyle would have us believe that he was 72 kilos at the Tour de France. Armstrong is on the record saying that he was absolutely fastidious about what he ate, and when he ate and how he ate. It is incomprehensible that someone would get himself into such perfect condition and then essentially eat like a horse so that his body weight ballooned up to 79 kilos, and then somehow intend to go back through that hell to lose 7 kilos again for the next race. That's just not true, it doesn't happen.

Armstrong acknowledged under oath that his body weight never got to 72, he was a little vague, but he said he was happy when he raced in the 74's. Now if you admit you were probably 74 you were probably a lot heavier than that.

It all comes back to this mystery. It's power to body weight that determines your performance, particularly in mountain stages. It's all power to weight ratio. If people know how much you weigh, they can then extrapolate back from your times and your speed, and get a pretty good approximation of what your power output must be. And once you know the power output and the body weight, then you can get a pretty good guess at what the VO2's were like. And when you start plugging some of those figures back in, you see that during some of his performances at the Tour, his VO2 must've been through the roof. Some people say it had to be in the 90's. Now, that's just not physiologically possible, when at other times they're in the 70's.

And that's what Coyle documented in his paper. So the way to get around that, if you don't tell anyone your body weight, they can't even get the first step towards estimating what your power outputs and VO2 must been. And that's just not Armstrong. Most riders are pretty cagey about revealing that because it would give their competitors an insight into their physiological limits, and therefore a strategy to defeat them. So before Coyle's paper we had nothing, no idea at all. And then the paper comes out, all of a sudden the cloak's pulled back, and what is a fairly modest, in elite terms, profile is revealed. There's nothing special about Armstrong's physiology at all.

AS: Coyle makes a big deal of his heartrate being able to go over 200, that it was a contributing factor in his dominance. I think he even said it's unusual for people to go over 190, which I find ludicrous. I have many friends that go into the high 190's. Is there anything to the high heartrate theory?

MA: No, of course not. Any recreational cyclist who rides within a group on weekends will know. Some people heartrates are high and some people's are low. It's really go nothing to do with your maximal performance capacity, and Ed Coyle knows that. And it still beggars belief how he would attempt to perpetrate otherwise in front of a cyclist audience. To me it's just nonsensical.

Coyle's study at the SCA arbitration

AS: And just to clarify, the reason we're talking about this, Coyle was used as an expert witness in the arbitration case where an insurance company refused to pay out a bonus, and so he was called to prove that Armstrong was able to win the Tour without doping.

MA: Essentially the arbitration was between SCA promotions and Tailwind, who'd taken out a contract that said if Lance Armstrong wins X Tour de Frances you will pay him bonuses, and the bonuses began around a million dollars and increased up to the last victory where he was due a payment of five million dollars.

Now, this began when some of David Walsh's information became public, there was a real growing body of evidence suggesting that Armstrong had doped. SCA's position was, "Hang on a minute, before we pay you this last bonus," they'd paid out all the ones before then, "before we pay this last bonus, we need to get to the bottom of this. Have you doped or not?"

At the end of the day, the case, and Armstrong's lawyers made this argument themselves, in the end it was irrefutable. The case came down to "Does the contract say you'll pay him if he wins?" And the contract said that. It didn't say anything about "We won't pay if you doped," or any clause that if there's any suspicion of doping we won't pay you out. It was a simple black and white: if you win you get paid.

That became apparent during the case, and it was recognized that because of that letter of the law, there was no way that SCA couldn't be held liable to pay that amount out. And for that reason they ended discussions and the case was settled out of court. The hearing body wasn't asked to rule did Armstrong dope or not. The hearing never had to make the ruling, because the case was settled, and it was settled because both parties recognized it was simply a letter of law, he had to be paid because he did win the Tour.

So all of this evidence that was brought to the hearing was brought with the understanding that the hearing would take a slightly different view of things, and it wasn't supported in the end, but all of this evidence was nonetheless brought to the hearing, and Ed Coyle was asked to be a witness and produce his paper to defend our allegations that Armstrong had doped.

(Dr. Coyle has been contacted twice to respond to these charges. If he agrees to talk to me I'll run his response unedited.)

Tyler Hamilton, a brief history of blood doping

AS: You developed the test for homologous blood doping, which eventually caught Tyler Hamilton.

MA: That's right. The test was introduced at the Athens Olympics in 2004, and there was initial evidence of transfusion even before the Olympic games, there was more evidence during the games, and then during the Vuelta immediately afterwards he failed both an A and a B sample. And that was when he was sanctioned.

AS: And in fact at the Olympics, it was because his B sample was mishandled that he got away with it.

MA: Yeah, the A and the B sample rule dictates that the A has to be positive, then the athlete is allowed to come in and witness the B sample being opened and tested. The test for homologous transfusion relies on the red blood cells being intact. And what the laboratory had done was to freeze the B sample. It's a little bit like when you freeze water, it expands. When you freeze blood, the red blood cells expand and burst.

Once it'd been frozen it was unusable for our test and so the B sample couldn't be analyzed, therefore he couldn't be sanctioned.

AS: Maybe we should go into a little bit of the history blood doping. Transfusions had been around, and I guess EPO replaced it because it was easier - you didn't have to draw blood, you don't have to risk putting someone else's blood in you.

MA: It's interesting, the history, because probably it wasn't until the 1968 Olympic games in Mexico City that coaches or athletes or physiologists for that matter really took much notice of altitude or oxygen consumption or for that matter blood doping. And in the leadup during the games which were held at altitude, people realized how dramatic the impact on performance was, when you had less oxygen available to the body.

And it was a relatively straightforward link to say, well, if the body suffers when there's not enough oxygen, it'll probably perform better when there's extra oxygen. And that's the basis of blood doping. You put more blood into the body so that it transfers more oxygen into your muscles, and you perform better.

So that was in 1968. Probably midway into the 70's we begin to see anecdotal reports of athletes experimenting with blood transfusions, EPO wasn't invented at that time, so it was conventional blood doping: taking blood out of one person and giving it to you, or storing your own blood in the refrigerator for several weeks, and putting it back in just before you race. So that was present during the 70's. As late as 1984 at the Los Angeles Olympics, the US cycling team at that stage were practicing both homolgous transfusion, which is using someone else's blood, and autologous transfusion, which is using your own blood.

Soon after the IOC were put under a lot of pressure to ban this practice, at the time it was considered unethical but it wasn't banned, so soon after that there was a ban in place, but because it couldn't be tested for, there was nothing to stop its use. But it is a pretty time consuming and messy procedure. You've gotta take the blood out and store it, it could get contaminated or infected in the meantime, then put back in.

During the mid 90's, they isolated the gene that produced EPO in the body. They were then able to make synthetic EPO, and that was a much easier scenario. It was as simple as taking a few injections, three or four injections, and you got the same benefits, probably even more so, than if you used blood transfusions. In the mid 90's EPO overtook transfusion. It's a lot quicker and more effective.

And then in 2000 when there was a test for EPO, we suspected that probably shied some of the athletes back towards transfusions, which at that time were undetectable. So it was kind of this middle period straight up after 2000, where we suspected the athletes resorted back to transfusions. They were still using EPO but transfusions reappeared.

And it was on that basis that we did the research and introduced the test for homologous transfusion, because that in particular is a horrendous, especially dangerous method of blood doping. The risks are very real and very severe. So there was a very strong medical and moral reason to bring in a test, to stop athletes from going down that path.

And that's pretty much where we are five years later. We have the test for EPO, we have the test for homologous transfusion, but there's no test for autologous transfusion, and we know that athletes, by carefully monitoring their EPO injections, can continue to get away with that as well. So that's the scenario we're faced with at the moment.

AS: The EPO tests probably brought about Puerto? The storing of blood bags and so forth?

MA: I guess you could make that speculation. I don't know that it's quite as simple as that, other than to say that Puerto seems to have occurred from early 2000 onwards. The timing's at least coincidental.

The Bio Passport

AS: There's no test for autologous transfusion, though there's news today that a new test might be developed. Is that where the longitudinal passport concept comes in?

MA: The passport, we held a lot of hope that it would reveal autologous transfusion, the underlying theory is that if you re-infuse a bag of blood, then the concentration of red cells in circulation, the hemoglobin concentration, is going to be increased. And we should be able to spot the elevated values compared to what it was before the transfusion.

The unfortunate reality is that we've conducted a couple of studies in Denmark where we have replicated that practice in volunteers, and we were puzzled and disheartened to find that there just wasn't the increases in hemoglobin that we had expected. For some reason the body regulates differently between transfusions and EPO. With EPO your hemoglobin rises markedly. With transfusions it just doesn't seem to.

We don't fully understand why, we've got a few clues, but the bottom line is yes, transfusion is apparent in the blood passport approach, but the changes aren't usually substantial enough that in itself we will be able to impose a doping violation just on changes in the blood. We would probably need to supplement that with other sorts of evidence.

AS: Is that why no one's been caught using the bio passport to date?

MA: No, that's more related to the care and the diligence that the UCI is using to gather all of the evidence they'll need before they'll prosecute the first case. So no, there is no relation to that.

Police Intervention

AS: It's said that dopers are nine years, a number of years ahead of the testers. A lot of the famous cases are broken by traditional police techniques: surveillance, raids, etc. Is that, moving forward, how most dopers will be caught?

MA: Yeah, I think that's a very insightful comment. If we look back, certainly over the last decade, the major drug scandals that've raised the awareness of drug usage, that have confronted the public with how it is, they've all come from police style investigations. You talk about Puerto, or Balco, or Austrian skiers at the Olympics, all of those came from a police intervention of some kind.

If you look back, really the only significant high profile case that was purely from a doping control standpoint, is probably Ben Johnson in Seoul, and Floyd Landis at the Tour de France. Other than that, I think you struggle to really come up with a big fish caught with a doping control.

I think that speaks to how loose urine control has been historically. It has been too easy for a loophole to be found, and I think the results speak for themselves. With EPO and growth hormones, it's slightly different, because the molecule itself is just so hard to detect. That's a technological challenge as well as a logistics challenge, getting the doping control officer to the athlete at the time when the drug's present in the urine.

So I think the passport will take us a big step forward, not necessarily because it will be where sanctions are suddenly imposed, but because it tells the agencies which athletes are suspicious and which are not, or for all accounts clean. So you can focus your tests accordingly. Rather than having a pool of a thousand athletes, suddenly you narrow it down to a pool of say, fifty, and you focus your testing on those. And I think that indirect benefit of the passport, plus the continued police involvement, are going to be the cornerstones of the anti doping efforts. At least in the foreseeable future.

AS: So the passport may not catch someone, but someone might find himself subject to more 'random' tests?

MA: Exactly. And when you've shown these unusual variations then you can expect the federations will continue to pursue you until your values came back to normal and stopped deviating, or you're caught and sanctioned. It's an element of the passport that perhaps wasn't emphasized as much as it could've. There are some people who believe that's what the passport is best suited to do, to highlight the athletes who are doping so that you can then follow up with targeted testing.

Crime and Punishment

AS: Is doping criminalized in Australia?

MA: No, it's not, and it's a little perplexing to me, because many times the Australian model is held up to be the world's best practice. But it's not criminal, there is a dialogue between Australia's anti doping agency and our federal police, and that's resulted in low level athletes being caught. District level basketball or football players. It still hasn't netted any big fish, high profile successful athletes. The ones who are winning competitions, to my mind, they're the ones we need to satisfy ourselves either they're doping or they're not. They're the ones getting the publicity and they're the enticements for other athletes to use drugs.

Once we take care of those, I think we're going to be a lot further down the road to controlling this problem. At the moment Australia doesn't have criminalization for possession of some of these banned substances, even though law enforcement agencies are cooperating with anti doping agencies. I think we've got a little bit of room where we can improve on the domestic front.

AS: It's also not criminal here in the US. Just today we see that Bernard Kohl was caught, and he might spend up to five years in jail. It seems that for a lot of riders, they might get banned for two years or life, it's nothing compared to the prospect of jail time.

MA: Actually, if you sort of get into this conversation, you begin to look at some of the implications, it's not cut and dry to me. I don't disagree that if it's a criminal activity to possess or traffic a drug, and an athlete is caught doing that, they should face criminal prosecution. I have no argument about that. I'm not particularly sure in my mind that an athlete using drugs in a context outside of that stipulated criminal activity, I'm not sure we should regard them as criminals. They're not murdering people, they're not kidnapping anyone, they're not extorting anyone, they're breaking a rule of sport which says you don't use this particular drug when you compete. You can use it in hospital to make yourself better, but you can't use it when you're playing sport.

It's breaking a rule of sport in my mind, and I think we need to maintain that perspective. I don't for a second condone it, but at the same time, we need to recognize that these guys aren't committing a criminal activity unless in a specific country it's categorized as that. I think it's a symptom of our anti doping efforts' frustration at not being able to identify who the athletes are who are doping and when they're doping.

And the response to that frustration is, well, when we do catch them, by hell you better believe we're going to punish them. There's people arguing at the moment it should be a lifetime ban the first time you're caught. I think that's a symptom of that frustration, "Gee we only catch one every x number of years, and we gotta make an example of him." I just think we're getting a little bit hysterical, and perhaps we're losing that perspective of what we're trying to do and how we're trying to do it.

An empathetic approach

AS: Interesting. It's interesting for me to hear that for someone who's working so hard at anti doping, you have a very measured view of it.

MA: Well, it probably doesn't come across in most media because more often than not I'm being asked to defend the science of our tests, for example in the Hamilton case. Or I'm being asked to defend my opinion regarding Armstrong. Now, they're fairly polar circumstances. I believe that, I know that I carry out my research with the highest possible integrity. And I am empathetic with athletes, that is my background. I worked with elite athletes and that is my original passion.

I only became involved in anti doping so that I could stop doping and come back eventually and begin working with athletes again, and reassure them that you can be clean, you can compete, and you can win if you're good enough. I couldn't do that back in 2000 'cause I knew athletes could still get away with doping, and therefore whatever I did to help an athlete prepare wasn't going to be enough. So I felt I was better off using my energy in that field of anti doping so that in the long run I could come back to where I wanted to be. So I empathize with the athletes.

Something that sits at the forefront of my mind, a discussion that I had with a group of cyclists, I'm not going to say who they were, and I said to them, "Look, guys, if you tell me what you're doing, I don't need names, so I can go away, develop that test, and come back here and remove that particular doping problem once and for all."

And their response is still a guiding light to me. They said, "If you can come back to us with a test that captures everyone so that we can all stop, you can expect us to support it. But if you come back with a test that only captures a quarter of the people, and those quarter are punished but then they're replaced by another quarter and the problem keeps going, don't expect us to support it. Because you're destroying careers and families and livelihoods, and you're not getting rid of the problem." And I've always held that as an ultimate goal.

That's why I was particularly proud of our homologous test, because there is no way you can get away with homologous doping now if you're tested. It's as simple as that. I believe that the incidence of homologous doping is virtually zero. I think the only time an athlete would get caught now is if they've made a mistake and put someone else's blood in them when they thought they were putting their own.

And that's the sort of strategy that I think if the scientific world can come to athletes and say, "Here, this is a test that will stop doping," I think the athletes will support it 100% and I'd expect them to. And until the scientists can come to the athletes with that argument, we're forever in this grey area where "We'll get some of ya, and we sort of wish you'd help us catch some of ya", and on a personal level I can see that's just not...it doesn't comply with human nature. We're asking the athletes to do something which, I don't think if I were in their position I would do either.

Which is to say, you talk about the Simeoni's and people who speak out, overnight they virtually, well they do jeopardize their career, and perhaps they even destroy it. And what has it achieved? Some could say it has raised awareness, but has it changed anything? And that's an incredibly hard choice for us to foist upon an athlete, to say, "We want you to be brave, stand up in the media, tell us that you doped, tell us who else doped, and we'll publicize that story." Now, the athlete could do that, next day, particularly with this omerta in cycling, the guy's going to be out of a job, he's gonna be ostracized from his friends and his peers, and a week later that newspaper is fish wrappings, and nothing's changed. That's the sort of humane perspective that I always try to keep with me, and as I've said before, it doesn't show usually, because I'm being drawn into these polar arguments of yes and no, right or wrong.

AS: It seems we've come full circle. In my first question I asked about your work at AIS, where you were doing performance enhancing work, making athletes better, and you found that there was no point until anti doping was perfected. In a way, this is the ultimate performance enhancing measure, isn't it?

MA: Yeah, I guess, if ever I ended up back at the AIS or working with elite athletes again, I'd like to think it was because I felt satisfied that the job or the task I've set myself has been accomplished. Today, I have to be honest, sitting with you now, I'm not all that confident that we will reach that, not in the foreseeable future, but at the same time I do have cautious optimism that we can improve things and make them significantly better. Perhaps not bring them down to 0%, but I do think it's achievable that if an athlete dopes and wins, he'll be caught. He could dope and not win, and might not be tested or might not raise any suspicions, but if he wins, and he dopes in order to win, he'll get busted. To me, that would be a point where I could say, "Great, I'm going to sit back and I'm going to do the things I really enjoy doing now, because my job is done."

Dr. Ashenden was kind enough to respond to some follow up questions. Here is his email to me:

Dear Readers,
I realise the interview contained confronting material, addressing many different issues. Andy has asked me to respond, and for those of you with sufficient mental stamina (which, unfortunately, is not known to improve even if you read for 3-6 hours per day) I would make the following points.
1. Guilty or not of doping. Lance Armstrong is not a convicted doper, he has never been found guilty of doping, and he has steadfastly maintained his innocence. As far as I am aware, Marion Jones is not a convicted doper, she has never been found guilty of doping, and she steadfastly maintained her innocence - until she admitted lying to a federal investigator about taking banned substances (note: lying to a federal investigator is NOT a doping offence). Whether or not their respective sports can benefit from increases in mechanical efficiency, neither athlete has ever had a positive doping sanction imposed. To put it simply - not testing positive does not establish that an athlete did not use banned substances.

2. Remuneration. Yes I was remunerated ($150 per hour + expenses)  for my role in the SCA case. I would be very surprised if any expert witness, including Professor Coyle, was not (the $2.5 million SCA had to pay in penalties included payment for Armstrong's legal team and expert witnesses).

3. Do financial payments influence outcomes? Interesting point. Its public record that Armstrong donated $1.5 million to the Indiana University Hospital a few days after his oncologist delivered an affidavit stipulating Armstrong's medical treatment. Its also public record that Armstrong paid an undisclosed sum to the UCI who were responsible for conducting and reporting his doping controls (I say ‘undisclosed' because under oath Armstrong could not remember how much, to whom, or when he made the payment, only that he did send them money whilst he was competing). Moreover, Armstrong benefited to the tune of $5 million from the SCA case, yet his testimony/evidence was relied upon. Perhaps financial remuneration, and how that influences your conduct, is a tricky issue to tackle? So, back to my original point: if one asserts that financial payments may influence expert witnesses carrying out their duties, then one must also acknowledge that it is conceivable that financial payments might influence other entities as well.

4. Trust. See page 179 of "Its not about the bike", where Armstrong says: ""The old me had weighed 175 pounds. Now I was 158, my face looked narrow and hawkish, and you could see every sinew in my legs." In the context of the book, this was post-cancer shortly before he resumed racing. 175 pounds (~79kg) vs. 158 pounds (~72kg). Later, Armstrong confirmed under oath that he had never raced at 72 kg - yet this leaner body weight has entered folklore (and Coyle's publication!) as the explanation for his improved performance. He had lied to the public about his weight loss. To quote Armstrong's agent Bill Stapleton, when questioning the motives of allegations against his friend: "He lied once, therefore it brings everything else into question".

5. Interpreting the urine results. I expect people to challenge my interpretation of the science, and rightly so. I do have some experience interpreting results - see here the link to a peer-reviewed article  I wrote describing how the percentage basic isoforms are reduced in the hours/days after an EPO injection (http://www.haematologica.org/cgi/reprint/91/8/1143). I'd also direct you to the WADA website where you can practice for yourselves to see if you can visually tell the difference between a doped sample and a clean athlete (http://www.wada-ama.org/rtecontent/document/td2007epo_en.pdf see Figure 1 on page 3 where the right hand lane = ‘clean'). It's not always that clear cut, I admit, but it gives you some idea of what the lab has to do to determine whether or not a sample has synthetic EPO!). It's not the rocket science it is sometimes made out to be...but you do have to rely on the expertise and experience of the lab who generated the gels. In the case of the 99 Tour samples, the gels were generated by the lab who developed the original test, so their expertise is self-evident.

6. Comparison of pre vs. post cancer performance. Apparently some readers have objected that my comparison lacked scientific credibility. I accept that criticism as justified (it was a very long interview...). However his times, performances and those of his rivals are again public record - they do not mandate scientific interpretation. Time trials are perhaps the fairest way for a lay person to compare performances across time. It is a statement of fact that he lost minutes during time trials pre-cancer, and gained minutes post-cancer, compared with his rivals. David Walsh's book(s) address this in more detail for those interested.

7. Finally, I wish to add comment about the recent sample collection in France. Lance Armstrong is the self-proclaimed ‘most tested athlete in the history of sport' which infers he well and truly knows the drill - when you are notified to provide a doping control you MUST be chaperoned at all times until the urine sample is provided. The athlete is not allowed to leave the tester's presence (this is an age-old guard against the athlete attempting to mask drug use, for example by placing soap under their fingernails and discretely adding this to their urine sample so as to destroy proteins like EPO in the urine). Obviously I have no evidence to suggest this is what Armstrong did. But I find it curious that he feels he has special dispensation to leave the tester's sight and take a shower. Perhaps old habits die hard?

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