The Shadow of the Syringe

What happened to Paul Köchli's idea?
Jean-Paul van Poppel to David Walsh, July 1993

Looking across my bookshelf this past week, I thought it might be worthwhile to pull together what commentators and former riders have had to say about cycling's culture of the syringe and the general medicalisation of our sport. To see what some have said about why we might need a no needles policy.

Before getting into that, one historical note. In 1964, at the Tokyo Olympics, Pierre Dumas, with the support of the French Sports minister Maurice Herzog, convinced the UCI to allow him carry out a rudimentary doping control on cyclists at the Games. This chiefly consisted of examining the riders for evidence of recent injections and, if found, asking them what they'd taken. Forty-seven years later, the UCI seems finally to be catching up with men like Dumas. And - as we'll see shortly - finally be catching up with a man who, more than twenty years ago, had a no needles policy on his teams.

Let's begin our trawl through my bookshelf with Allan Peiper, the Australian directeur sportif with HTC and himself a former domestique - and sometimes a handy prologue rider - in the eighties and early nineties. In his book, A Peiper's Tale, he talks of his arrival at Peugeot and his introduction to syringes:

I thought I had been looking after myself, and turned up at the first Peugeot training camp with my garlic pills and wheat germ capsules, but the first thing I learned was how to use a needle. Not for doping, but for vitamin injections, because if you need vitamins it is more effective to inject them.

The whole thing was treated as a sort of initiation rite. Everyone would be in the soigneur's room and you had to inject yourself in the backside while they all watched you. And you couldn't throw the needle in, you had to push it in slowly so that you could feel it going through each layer of fibres. The guys would be lying around on beds and sprawled in chairs, laughing at your discomfort.

Now, to people not involved in cycle sport, that might sound a bit frightening, but it was part of your job. Your job was to be in as good a condition as possible, and it was your responsibility to ensure that. Taking tablets just won't do because your body is not forced to take up the vitamin; the tablet has to be digested and the digestive system might not even absorb the vitamin. With an injection, especially intravenously, your body has no choice but to absorb it.

Paul Kimmage, in A Rough Ride, echoed this last comment from Peiper, when he wrote about the first time he allowed himself to injected, during the 1986 Tour de France:

Riding six hours a day for twenty-three days was not possible without vitamin supplements, mineral supplements, chemicals to clean out a tired liver, medication to take the hardness out of rock-hard leg muscles. Taken in tablet form the medication passed through the stomach and liver. This was extra work for already overworked organs and the result was that much of the benefit of the product was lost. Injections avoided this and were therefore more efficient. A syringe did not always mean doping.

In a perfect world it would be possible to ride the Tour without taking any medication, so long as everyone else did the same. But this was not a perfect world.

We were not doping, we were taking care of ourselves, replacing what was being sweated daily out of our bodies. The substances taken were not on the proscribed list, so how could we be doping? And yet one thing was becoming clear to me: as soon as you started playing, as soon as you accepted the taking of medication, the line between what was legal and what was illegal, between taking care of yourself and doping grew very thin. Most fellows cross it without ever realising they have.

That the simple use of legally allowed products could lead to doping is something Laurent Fignon also noted, in his autobiography, We Were Young And Carefree:

In this ultra-medicalised little world where there are countless suitcases of remedies going the rounds, there was always the temptation to take something like a vitamin or a supplement, just to make sure. To ward off I don't know what. Looking logically at it there are times of the year - particularly when it's cold - when you have to look after yourself if you're going to ride a bike seriously. That is habit-forming, and those habits can degenerate. To do the job as well as you can, you can end up believing that medicine of all kinds is as integral to cycling as the bike itself.

Not everyone believed that needles and pills were necessary. When David Walsh spoke to Jan-Paul van Poppel in 1993 - for Walsh's book about the 1993 Tour de France, Inside The Tour De France - the Dutch sprinter explained how he himself had demurred when first faced with injections, asking if he couldn't take the supplements orally. He was told he could, but this wasn't efficient as it would tax the stomach and the liver and thus cause more problems. In the end Van Poppel gave in to the needle. But while he acknowledged that some riders needed recourse to supplements, he also pointed out to Walsh that this was not a universal truth:

People see injections as doping. They think if you take one before a race it has to be illegal, even though you have just taken something for an infection. A man riding the Tour de France needs more vitamins than the normal person. In my mind what is not on the [banned] list is not doping. But there are riders who ride the Tour de France without vitamins and all that stuff. It's possible.

Van Poppel went on to remind Walsh about Paul Köchli, the Swiss directeur sportif who believed that the received wisdom about it being impossible to win the Tour without drugs was wrong: "One day the immense majority of riders, the immense majority of the public, will confirm that." Among his roster of riders were Gilles Delion - who just about everyone always pointed to as one rider in the peloton who rode clean - and Steve Bauer. Here's what Van Poppel had to say to Walsh about Köchli:

I know Paul Köchli's team: they never rode with vitamins or anything else. He was against all this. He doesn't like injections, just Supradine. No needles, never. It's possible for a strong rider like Steve Bauer, who rode in Köchli's team, but when you're like Jos van Aert or Martin Earley, then maybe it's a problem. They are skinny, they haven't much reserves and they are likely to get ill.

Van Poppel, who clearly seems to have had some admiration for Köchli's principled approach, tried to explain his distaste for doping to Walsh, closing with this:

I have never been positive in my career. Please, don't let's talk about this. If you were positive, people would look at everything you've won and say you were once positive.

Van Poppel saw out another two seasons without tripping any positives and then hung up his wheels, becoming first a coach of the Dutch national women's squad, then becoming involved with Cervélo and this year taking up a position with Vacansoleil. Unfortunately for Van Poppel, not testing positive stopped being enough a long time ago. Today, people look at the Dutch sprinter and say he was once a member of PDM and then Festina. The syringe casts a long shadow.

Walsh spoke to Köchli. The Swiss directeur sportif had raced three years in the pro ranks, at the end of the sixties, before being forced out of the sport with health problems. He had started the 1968 Tour but was a DNF. The following year he rode with Jean de Gribaldy's Frimatic team. After he hung up his wheels, he became a cycling coach. In 1983 he became a directeur sportif with Bernard Tapie's La Vie Claire squad. In 1988 he formed his own team, Weinmann-La Suisse (later Helvetia-La Suisse), and that lasted through to 1992.

Greg LeMond has occasionally used Köchli's presence at La Vie Claire as evidence that there was no doping there during his time with the team: "Every rider on La Vie Claire was clean; that was Paul Köchli's big deal to make sure he had a clean team." This may have been true for some of the riders, but it definitely wasn't true for Kim Andersen. On this subject, Köchli was somewhat circumspect when speaking to Walsh:

About my experience in France, I cannot say no one ever took drugs. I never saw it but I know it might have happened. I started to change the team because of this reason. The difficulty was that at the time I went to La Vie Claire, the team was already built.

That Köchli was ahead of his time is evident in how you can hear the words of contemporary team principals in things he was saying two decades ago. Try this: "many riders are dependent [on drugs]. It is like a ritual, they cannot live without them." Today Dave Brailsford struts around saying similar things to British journalists as if he were the first to ever realise this.

Köchli didn't just kick against the pricks, with his no needles policy. When it came to the issue of the medicalisation of cycling he was something of a puritan. He was against the notion of teams having dedicated doctors as part of their personnel:

I never had a doctor in my team, except in the Tour de France and his only role was to treat those with a real health problem, a flu or an infection. [...] The presence of a doctor in a team is usually a bad thing. Riders are healthy, so why should they need a doctor? In my experience doctors are generally very bad physiologists because physiology is how a healthy organism functions and doctors are more used to unhealthy people. Their perspective is the wrong one.

Back then, nearly two decades ago, Walsh - today the big bad Irish wolfhound who is likened by some to a twenty-first century Torquemada leading the witch-hunt against Lance Armstrong - believed that the increasing medicalisation of cycling was a good thing. For Inside The Tour De France he interviewed Nicolas Terrados, team doctor with Manolo Sáiz's ONCE squad. Terrados's PhD thesis was on the effects of altitude training.

When Walsh spoke to the Spanish sports' physician during the 1993, four of the team's riders (Erik Breukink, Laurent Jalabert, Alberto Leanizbarrutia and Neil Stephens) had quit the Tour, something they ate at the hotel in Marseilles - bad fish? - giving them food poisoning. Manolo Sáiz's teams never did learn to stay away from the poisson.

Walsh applauded the professionalism Terrados and his ilk were bringing to cycling. But there is one area where Walsh seems to have had qualms, and that is the issue of ethics. In the interview, Walsh presses Terrados on this subject but the doctor refuses to give a clear answer, the best he can offer is that, ethically, doctors are better than soigneurs. Five years after Walsh interviewed him, Terrados was one of the many suspects rounded up at the 1998 Tour de France and charged with facilitating doping.

Back then, in 1993, Paul Kimmage too seemed to believe that the arrival of dedicated team doctors was a good thing for cycling. Here's what he had to say to Walsh for Inside The Tour De France:

The biggest problem the rider has is his own ignorance. There was no doctor in our team [RMO] to take a blood test, nobody to say 'Hold on, the exhaustion you feel is normal. You produced too much lactic acid in yesterday's time trial.' I mean there was nobody to explain what an anaerobic threshold was and I hadn't a clue. I didn't know what the B12 injection [I took during the 1986 Tour] did for me and I only agreed to it because the directeur [Bernard Thévenet] suggested it. Bringing well qualified exercise physiologists into teams should bring about an improvement. But they must explain things. Provided they do, the riders will understand their own bodies better and will be less ignorant about what they should and shouldn't be doing.

To a limited extent, one can understand where Kimmage was coming from here. But his belief that doctors would explain things seems naïve. It is true that in the days of soigneurs riders could be left ignorant of what was being administered to them. This is how Louison Bobet's soigneur, Raymond le Bert, excused Bobet's doping, saying that he administered doping products without telling the three-time Tour de France winner what they were. Plausible deniability I think some might call it. And, of course, this is the lifeboat Richard Virenque clung to during the Festina trial, claiming that Willy Voet had doped him without his knowledge.

But how different was it when the doctors came along? One of the most important team doctors in the nineties was Sabino Padilla, the Banesto physician, the man in charge of Miguel Induráin. Thomas Davy, a domestique with Banesto in the nineties, offered this testimony of his time with the Spanish squad, during the Festina trial in 2000:

I took EPO - I think. The doctor, Sabino Padilla, came into the riders' rooms after the stage. The syringes were prepared in advance [...] We asked what was in the syringes, but he never replied [...] No one ever found out. These injections were systematic during major races, especially the Tour de France. We imagined it must be something stronger than recovery products [...] We generally rode better after those injections.

At other teams he rode with, Davy seems to have been more aware of the drugs being administered. At Castorama it was corticosteroids. At Française de Jeux he was provided with EPO by Jef d'Hont.

It is easy to look at the likes of Bobet and Virenque and even Davy and wonder how they could not know that they were being administered dope. But what about those at the sport's entry level? Even asking questions about what was in the needle being administered to them was - is - no guarantee of getting an answer. Or even getting the right answer.

Consider the case of Greg Strock, as explained by David Walsh and Pierre Ballester in their LA Confidentiel. Strock was a member of the American junior national team in 1990, where he was coached by René Wenzel. The team was racing in Europe when Strock came down with a cold. A doctor prescribed antibiotics. When Wenzel - with advice from a French soigneur - found out, he told Strock to give up the antibiotics:

I was told I needed an injection and was given one. As well as that I was also given these vials and pills, approximately seven to ten days' worth that were to be taken each day in the case of the vials, and the pills twice a day. They were described to me as 'a variety of pills and extract of cortisone.' Other than a vaccination, this was the first time I had been given an injection.

At the time, we were starting to find pills pushed into our energy bars. I distinctly remember the first time it happened, biting into a bar and wondering why it tasted so awful. I bit into something strange and could see the cross section of a pill. At first, I thought someone at the store must have tampered with it; then I realised our own guys were doing this.

I was aware enough to ask questions: 'René, does this pose a health risk? Is it allowed?' I was reassured every time and it was the same for the other riders on the team. You could call it a brainwashing. We were told, 'Boys, at sometime in your professional career, you have to take products to increase performance.' Or 'Anyway, it's just something for babies, it's legal, there's no problem.'

It was their way of leading us into the doping culture, by minimising the bad that they do and reminding us that one say we were going to have to take the 'real things.'

When the Scottish soigneur Angus Fraser joined the team, Strock continued to ask questions, especially as Fraser administered injections as well as massages:

Sometimes the injection came first; other times the injection came afterward. At one point we were getting two or three injections a day. I questioned René: a bit. 'What is this?' 'Is it legal?' In his eyes I was a nuisance. 'Damn it, Greg, if you want to succeed as a pro, you are going to have to learn to trust your trainers and coaches. The pros on the Tour don't waste this kind of energy.' In England, I was told the injections were vitamins and cortisone extract. One time we were told it was an ATP injection.

The story of René Wenzel - Striock's coach at the time - is also worth considering. Walsh interviewed him for From Lance To Landis. Wenzel had been a Danish amateur in the eighties, before taking up coaching. While riding with a Belgian club he was sent to Bernard Sainz - the famed Dr Mabuse. Here's what Wenzel had to say to Walsh:

We were taken to a doctor, a man we knew as Dr Bernard. His full name was Bernard Sainz. We felt like pros when we went to him because if we were being put under medical supervision, that meant someone was taking us seriously. We also knew that Dr Bernard worked with Bernard Hinault at this time, and that was part of the sell for us. We felt honoured that Hinault's doctor would agree to work with us.

We'll skip blithely over Sainz's medical qualfication, as he seems to have skipped it too. Suffice it to say that he is a man who has a reputation. What Sainz did for Wenzel is what we're interested in here.

We had finished a training ride one afternoon, and those of us who lived in the area were told to stop at the directeur sportif's house. There was a box containing envelopes with each of our names on them. Inside each envelope was a bunch of tablets, one or two ampoules of liquid, and enough syringes to cover the doses outlined in the note describing what we were to do with the different products. There was also a substance that we were to take, one drop each day placed under the tongue.

We, the three Danish guys, had no idea. We hadn't injected ourselves before and so we ended up injecting each other. The French guys knew exactly what to do. [...] In his note telling us how to use the ampoules and tablets, Dr Bernard didn't say what the products were and there were no labels indentifying them. At the time I didn't think of it in terms of doping, but later on, yes.

* * * * *

The need for medical support is an aspect of the sport that some cyclists feel fans just don't get. Here's Allan Peiper again:

Medical support is really important, but I think that the outside world thinks that medical support always means drugs, that anything to do with a needle is drugs, but that is not the way it is, although I can appreciate that it's difficult for people to understand. I have had iron injected intravenously which I've heard is quite dangerous, but there was such a proven practice of doing it going on in cycling that it was accepted, and you could feel the effects immediately. Now that practice, and the mindset of allowing it to be done to yourself, might be hard to accept from someone outside of pro cycling.

Every now and then, the sport throws up a scandal which makes it even harder to fans to accept the sport's need for the level of medical support it today relies on. One such incident befell the PDM team at the 1991 Tour: the Intralipid affaire. Sam Abt had this to say about this affaire in his Champion: Bicycle Racing In The Age Of Induráin:

The use of hypodermic needles summoned up dramatic connotations in the popular mind, officials and observers of the sport admitted ruefully. 'If it comes out of a syringe, the public thinks it probably has to be dope,' says David Walsh, an Irish journalist and the biographer of his country's two leading riders, Stephen Roche and Sean Kelly. 'You're not dealing with a doping scandal here,' insisted a PDM rider who spoke only on condition of anonymity. 'What happened here was defensible. But,' he admitted, 'something went wrong somewhere.'

He, Walsh and others were quick to deny that there was anything sinister in the common, if unpublicised, practice of injections. 'Whatever it looks like,' Walsh said, 'many teams prefer injections to pills or syrup because injections work faster,' That was supported by the directeur sportif of a professional team, who also insisted on anonymity. 'Too many pills upset the stomach,' he said. 'So one injection is better than twenty pills.'

'Of course,' he added, 'nobody needs to take twenty pills either. With injections, however, there's a psychological advantage for some riders. It hurts, so they think they're getting something that the other riders don't have. Many traditional teams create a feeling with their riders that if they don't have injections, they feel less confident.'

Walsh's position on the Intralipid affaire is partly explained by the presence of Sean Kelly and Martin Earley on the PDM squad. He himself revisited the Intralipid affaire in his Inside The Tour de France. There he said: 

cyclists' age-old desire to hitch their systems to an outside motor has created perceptions which are hard to change and the picture of a rider being injected leads to one conclusion: doping. It is a mistaken view, out of touch with the realities of modern sport but, for the armchair enthusiast, nothing good comes through the tip of a needle.

Over the nineties and into the noughties, the Intralipid affaire was followed by many incidents which only reinforced the belief of the armchair enthusiast that nothing good comes through the tip of a needle. Most notably during the 1998 Tour de France. With the Festina affaire raging, journalists became dumpster divers.

During the rest day in the race, France 2 TV news showed reporters rummaging though waste bags left by the Italian team Asics. They found empty medicine boxes. The Asics doctor, Max Testa was interviewed. He was furious at the way the piece was handled, as he explained to Sam Abt for the latter's In Pursuit Of The Yellow Jersey:

The interview was supposed to be about how we prepare the riders, but then they started to ask me about all the products we use. Then they asked me about the products they said they'd found in the bins, saying that one was banned, but that's wrong - it's not a banned product. We don't use EPO - we use vitamin B12, iron and folic acid, instead of EPO. When I saw the film it had changed what I said, but they can come and check everything we use and they won't find any banned products.

Testa was not the only one who would rue the way the media presented all medical waste as doping. At the 1999 Tour de Suisse Lampre were photographed dumping medical waste. As well as medicines, used syringes were found. Thirteen different substances were identified by subsequent laboratory analysis, four of them on the banned list.

In 1999, two Danish journalists revealed footage shot during the 1995 Vuelta a España, in which ONCE and Française de Jeux had their medical waste poured over. The Danish duo recovered syringes and empty ampoules, which they had tested. The ampoules showed traces of EPO.

Lance Armstrong, writing in Every Second Counts, mentions one incident involving his US Postal Services squad, when a France 3 news crew filmed team personnel disposing of medical waste:

According to our team doctor and chiropractor, after a Tour stage in Morzine [in 2000], they had bagged up the garbage left over from our medical care as they normally did. They didn't want to leave it at the hotel where we had stayed. However, the more unsavoury media was always picking through our garbage in its relentless hunt to prove me a doper, and we resented it. So they decided to frustrate the press by taking it from the hotel in Morzine and throwing it away in a roadside garbage can. This was their 'suspicious behaviour.' The 'medical waste' consisted of some wrappers and cotton swabs and empty boxes, nothing more.

As well as some wrappers and cotton swabs and empty boxes, the USPS medical waste, which was dumped nearly a hundred kilometres away from the team hotel, included one hundred sixty syringes. Among the eleven different products for which packaging was found was the calf-blood extract, Actovegin, which has had an on-again, off-again relationship with the banned list.

This was not the only time USPS were accused of disposing of their medical waste as far from a race as they could. In LA Confidentiel, Walsh and Ballester tell a story, concerning the team's Irish soigneur, Emma O'Reilly:

At the airport Armstrong handed O'Reilly a black bag wrapped tightly into a neat package. 'Look Emma,' he said, 'I didn't get rid of these, will you dump them for me?' They were syringes; empty syringes that Armstrong had used during the race [the Tour of Holland] and did not care to leave in his hotel room.

If it was only the media looking at medical waste cycling could probably cope with the problem, by doing what it always does, and shooting the messenger. But it's harder to do that when it's judicial authorities who are examining what some teams leave behind.

During the 2001 Giro d'Italia Italianpolice found an insulin syringe in a hotel room recently vacated by Marco Pantani. Initially he received an eight month ban, having been found guilty of sporting fraud. There then followed a ludicrous back-and forth between CONI, the UCI and CAS with the former reversing the eight month ban on appeal and the latter refusing to grant the UCI's wishes to reinstate it. At one stage the UCI refused to recognise CAS. And it all began with an insulin syringe carelessly discarded in a hotel room.

* * * * *

Cycling is promoted as being the healthiest sport there is. Yet consider how much medicine - legal medicine - is used in this sport. Consider how races today have become pharmacies on wheels. The French newspaper Le Journal du Dimanche revealed in July 2004 that eleven non-French teams starting that year's Tour had requested permission from the Agence Française de Sécurité Sanitaire des Aliments to import medicines - lotions, potions, needles and pills - many of which have no obvious application within cycling. On average, these teams were each importing more than eighty different substances. One team imported one hundred fifty-five substances.

Commenting on the volume and type of legal drugs being imported, Gérard Guillaume, doctor to the fdjeux.com team said:

The cyclist's pathology is hypochondria: falls, skin irritations, digestive, pulmonary or muscular complaints. That necessitates around thirty products, no more. You can add to that a couple of medicines in case of an emergency, like a heart attack, but no more. Nothing justifies such an arsenal of products.

Nothing justifies such an arsenal of products? Well, maybe nothing except a Therapeutic Use Exemption. The AFLD revealed that, at the 2008 Tour de France, seventy-six of the one hundred eighty riders who took the line in Brittany needed TUEs in order to be able to ride.

Walsh and Ballester, in LA Confidentiel, procured the drugs manifest of one team from the 2000 Tour. It listed one hundred twenty-six products. Six hundred and eighty-four individual packages were detailed, which the authors calculated to amount to seven thousand four hundred and twenty-two individual doses. The 2001 manifest for the same team, which the authors also procured, covered one hundred and nineteen different products. Seven hundred and ninety packages were detailed, which the authors calculated to amount to eight thousand, three hundred and thirty-four doses. This is for a team of nine riders in a twenty-one day race. Do the math on the daily doses yourself.

Walsh and Ballester were minded to recall a comment from Daniel Delegove, the presiding judge at the Festina trial in 2000. Looking at the all the evidence he had heard about the use of drugs in cycling, Delegove declared: "These are not racers, they are cycling test tubes."

The authors also turned to Jean-Pierre de Mondenard, the author of the Dictionnaire du Dopage:

The main purpose of medication is to combat disease. Once medication is given to enhance performance, a doping system develops. Originally, sport had its virtues, but sport organised by man has eliminated them.

Would simply eliminating needles help return - or even impose - cycling's virtue? There have been too many false dawns in the past dozen years to believe this. But an initiative like the proposed needle ban does seem to suggest that some people in the UCI are finally willing to support those who wish to be virtuous, even if only so that in doing so a little bit of that virtue might rub off on them.

Nearly two decades after Paul Köchli was forced out of the sport by the impossibility of competing clean against Gen-EPO we may finally see our governing body embracing ideals he championed. Wherever he is now, I hope Köchli has a smile on his face at the prospect of a peloton-wide no needles policy.