Tough On Doping, Tough On The Causes Of Doping - The H-Test: What happened next.

Previously we've looked at the introduction of the Haematocrit test in 1997, and what was going on in the world of cycling around the time of its introduction. This time round we look at what happened next.

Slowly the poison the whole blood stream fills.
It is not the effort nor the failure tires.
The waste remains, the waste remains and kills.
Empson

With the haematocrit test in place from early 1997, the UCI and the IOC were able to turn their attentions to other problems. The IOC were quick off the blocks, Prince Alexandre de Mérode, President of IOC's Medical Committee, warning the world of a new danger: hyperbaric chambers. I'm presuming the danger here is your plastic tent collapsing upon you and you dying of asphyxiation. It's embarrassing enough when Conservative MPs and failed pop-singers have their deaths linked to auto-erotic asphyxiation, but world class athletes? Merde!

In 1998 however the UCI became aware of a far more real danger: perfluorocarbon. A blood substitute used for trauma victims who have lost large quantities of blood, PFC absorbs 20% more oxygen than organic blood, making it a powerful alternative to EPO. When it came to taking action on PFC, the UCI - according to its 2001 document, 40 Years Fighting Against Doping - moved swiftly and decisively.

EPO hadn't been banned by the UCI until 1991, even though it had been killing riders since at least 1988 and had been publicly linked to those deaths as early as May 1990. The H-test, we know, didn't arrive until 1997, and only then after others pressed the UCI into introducing it. But something about PFC really rang alarm bells in the UCI's HQ in Lausanne. In May 1998 they "pleaded with [the trade teams] not to resort to it and warned: 'The UCI will take strict action against all those who use this prohibited substance or who are involved in its distribution or administration.'"

40 Years Fighting Against Doping goes on to blow the UCI's trumpet on this issue: "From the beginning of the 1999 season, PFC was put on the list of prohibited substances. The UCI, which in August 1998 commissioned the University Institute of Legal Medicine (IUML) in Lausanne, headed by Prof. Patrice Mangin, to checking for any presence of PFC in the blood of riders, has never recorded an offence."

Chalk one up to the good guys? Well maybe we should reconsider what the UCI meant by never having recorded an offence and why they moved on the issue in May 1998. PFC had been known about since at least 1996. In February 1997 it was said to be being used by cross country skiers and speed skaters. So why the move by the UCI in May 1998? Could it by any chance have been related to an incident involving the Swiss rider Mauro Gianetti during that month's Tour de Romandie?

Gianetti collapsed during the race and spent two weeks in intensive care in a Lausanne hospital, a taxi-ride away from the UCI's then HQ. The surgeon who treated him, Gerald Gremion, said Gianetti's condition was consistent with a reaction to an injection of PFC. Gianetti of course denied this: "I was very ill with an infection, but I didn't inject myself with anything. I thought somebody had given me something that was bad for my health. The investigation is not against me. It is against somebody who could have given me something."

Whatever became of the investigation Gianetti referred to I don't know. The UCI's promise to "take strict action against all those who use this prohibited substance" proved to be just another toothless threat. Gianetti himself rode on for a few more seasons and when he finished riding got involved in the other side of the spot. In 2008 he was directeur sportif of Saunier Duval, where he was shocked to discover that one of his riders, Riccardo Riccò, had used EPO.

At that time Stéphane Heulot, one of Gianetti's former team-mates and a Saunier Duval press spokesman when Gianetti joined the team, spoke out against him: "In 2005, when they introduced Mauro Gianetti to me and said he was the new team manager, I thought it was a joke. I was his roommate at La Française des Jeux at the 1998 Tour de Romandie when he nearly died because he'd used a doping substance called PFC. Managers like Gianetti are so obsessed with doping that they can't conceive of cycling without it."

Was Gianetti the only one to use PFC? Despite the fact that the UCI proudly proclaimed that Patrice Mangin at the IUML had looked for and never once found any presence of PFC in the blood of riders, Emmanuel Magnien - a former Festna rider who rode the 1998 Tour n the colours of La Française des Jeux - popped a positive for a PFC derivative, PFOB, in 1998.

In April 2001 - three months before the UCI issued 40 Years Fighting Against Doping - Mangin and two IUML colleagues, Laurent Rivier and Martial Saugy, drew up a list of the principle doping products being used in the peloton, highlighting their side effects. As well as the usual suspects - EPO, steroids and corticosteriods - that list also included PFC. How Mangin knew PFC was being used if, as the UCI claimed, he'd never once found any evidence of its use in the blood samples he tested, is a question you'd have to put to him.

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Despite the alternatives, EPO stayed the real drug of choice. Some argue that the H-test actually encouraged people to use EPO, effectively legislated the use of EPO up to a certain level. Don Catlin put it like this: "The great majority of healthy males have baseline hematocrit levels of about 42%. The only way you're going to get to 49.9% is by using EPO. Now if you know that every other rider on the starting line is doped up to a legal 49% level, are you going to give them an advantage by not doping?"

In the first year of the H-test's implementation, nearly five hundred blood tests were carried out (the UCI actually promised seven hundred to a thousand tests). Ten riders were popped. It didn't take long for people to work out how to beat the test. All you needed was about twenty minutes notice that you were about to be tested.  If you knew your H-count was over the limit, all you had to do was dilute your blood. You could do this by drinking a couple of litres of water. Or you could try something more direct, like an IV drip. And since most of the cool kids in the peloton had their own centrifuge - as well as their Rupert The Bear flask to store their EPO in - everyone who was anyone knew their H-count.

Just because you have the latest toys though doesn't mean you'll always beat the test. As Marco Pantani found out during the 1999 Giro d'Italia, two days out from the finish and just before the race was due to climb the Gavia, the high-point of that year's race. Before the stage got underway, Pantani fell foul of the UCI's vampires, failed the H-test and got turfed off the race.

The year before Pantani's downfall, at the 1998 Giro, a Mercatone Uno team-mate of Pantani's, Riccardo Forconi, had also failed the H-test close to the race's finish, just before the penultimate day's time trial. Little fuss was made of that. What made Pantani's failure the following year significant was that - unlike Forconi - he was wearing the maglia rosa.

There's a strange story relating to that. Shortly after the 1999 Giro began, Ivano Fanini, the directeur sportif of Amore e Vita, claimed that, the year before, Forconi's sample had been swapped with Pantani's, allowing Pantani to go on and win the 1998 Giro. Mecractone Uno said they'd sue Fanini but never did even though, like most of Fanini's stories, the claim was never proved. Part of their reasoning might have been that rumours of something dodgy about the 1998 tests had actually been circulating since the end of the 1998 race.

But there is actually a more interesting story from the 1999 Giro, one that has a bearing on the H-test itself. CSAD - CONI's anti-doping committee, headed by Pasquale Bellotti - proposed carrying out a series of health tests at the Giro. As well as taking blood from the riders, they wanted to sample urine at the same time. The reason? Everyone knew that the blood test could be beaten (although that hadn't stopped two riders, Javier Ochoa (Kelme) and Nicola Loda (Ballan), missing the 1999 Giro having failed pre-race H-tests) but by sampling urine, Bellotti's CSAD team thought they could prove that dilution of the blood had taken place.

Dilution of the blood wasn't actually Bellotti's prime focus. In fact, he was concerned with what happened at the other end of the spectrum, when an athlete became dehydrated. Dehydration can push up the H-count. You may start the day with a H-count of 50% but, through dehydration, that could rise by several percentage points - how many is open to dispute, but Bellotti suggested five to ten. Stop and consider the consequences here: if a rider was starting with a H-count of 55-60% (quite possible, even with the 50% limit), at the end of a long, hot stage what level could it rise to? Could the blood become too thick to circulate, causing the rider to suffer a cardiac arrest? Was there really a possibility of riders actually having heart attacks in the middle of races?

But by being concerned about the effects of dehydration, Bellotti's CSAD test could also reveal if the opposite extreme was happening. Which might suggest that the rider had artificially diluted his or her blood. The science bit involves establishing the levels of creatininuria. If a rider tripped the test on that parameter, their blood sample would be subjected to a second round of tests, which would look at a much wider range of parameters, including ferritin levels, reticulocyte count etc. This second level of testing wouldn't find direct evidence of doping - but it could find indirect evidence. Effectively, it was a variant of the kind of EPO test Guy Brisson had developed in 1996, and a forerunner of the current bio-passport.

Bellotti's CSAD team - who had been working on the tests since the previous year - were not the only ones looking at some form of longitudinal testing as a way of combating doping. Don Catlin was another: "We have to change the whole culture of sport. We have to invest the money for more baseline testing. But instead of punishing athletes who stray from the baseline, we should reward those who keep on it."

As a response to the Festina affaire in 1998, the French introduced mandatory health checks for their riders. Each rider was required to submit himself to four tests a year. Once a base level was established, a rider would have to explain variances in their profile. In other words, a rudimentary bio-passport. When the French introduced their health checks a number of high profile riders removed themselves from France, Laurent Jalabert (then riding for Manolo Sáiz's ONCE squad) decamped to Switzerland and Richard Virenque (then still proclaiming his innocence in the Festina affaire) moved to Italy.

A key difference between the Italian and the French programmes was that CSAD was using in competition testing, not just the out of competition testing the French programme employed. Bellotti named his CSAD programme 'I Do Not Risk My Health' and it was, like the H-test itself, a health check, not an anti-doping test.

Bellotti and his team were given the go-ahead to carry out their tests on the 1999 Giro but the riders themselves, as at the 1996 Tour de Romandie, weren't very happy and - lead by Pantani - threatened to disrupt the race if the tests went ahead. Pantani, you'll recall, was one of a group of Italian cyclists who had called for the introduction of the H-test in 1996. Part of the riders' problem was that CSAD had no authority over non-Italian riders, so their tests would be limited to home participants. Another part of it seems to be that CSAD might have been on to something.

Eventually, the Italian riders were convinced to play ball with CSAD and voluntarily submit themselves to the new tests. The first tests were carried out at the start of the seventh stage of the Giro. The results were announced at the stage's end. Out of sixteen riders tested, CSAD caught two riders, Filippo Casagrande (Vini Caldirola) and Guido Trombetta (Mobilvetta), with abnormally low creatininuria levels. Their blood samples showed H-counts of 43% and 48%. Either they were ill, or they had diluted their blood to fool the H-test.

Under the rules agreed with CSAD, both riders were required to withdraw from the race and submit themselves to secondary tests. Trombetta withdrew. Casagrande withdrew from the testing programme. Other riders sided with Casagrande and also withdrew from the programme.

Mapei - the clean team with a dirty reputation - had been outspoken when the Italian riders originally wanted to boycott the CSAD tests. When Casagrande and others withdrew from the CSAD testing programme, there had been talk of boycotting the next day's stage of the race, talk lead by Pantani. Pantani and Mapei's Andrea Tafi argued the issue on TV that night.

We all know what happened to Christophe Bassons at the 1999 Tour de France. And to Filippo Simeoni in the 2004 Tour. At the 1999 Giro d'Italia, Andrea Tafi gave us a taste of things to come. The day after arguing with Pantani on TV, Tafi was subjected to a stream of abuse from the peloton, lead by Pantani. Some reports have him reduced to tears at the back of the peloton. After the stage Pantani justified his abuse of Tafi:

"A year ago, at the end of the Giro, someone at Mapei made very serious declarations about an imaginary exchange of blood samples, and these declarations cast doubt on the credibility of the checks. How can they say now: 'Let's do the checks?' Could it be that last year someone wanted Pantani's head at all costs, and didn't get it?"

At this point, Hein Verbuggen weighed in. Yeah! The UCI were protecting the little guy! Pantani was going to get smacked down for picking on Tafi. Er, no. Verbruggen ruled the CSAD tests a contravention of UCI rules. Only the UCI had the authority to take the piss. Or the blood.

Interestingly, at this point the CSAD testers were due to move up the food chain. Their first round of tests had hit only minor teams: Mobilvetta, Ballan and Vini Caldirola. Round two was going to look at Lampre, Polti, Riso Scotti and Saeco. They all refused to participate. So Mapei decided to stick two fingers up at Verbruggen and voluntarily submitted themselves to the CSAD testers.

The third and final round of CSAD tests should have looked at Amica Chips, Cantina Tollo, Liquigas, Mercatone Uno and Navigare. Needless to say, they didn't submit themselves to the CSAD testers.

Celebrating his triumph over the piss-takers in CSAD, Hein Verbruggen turned up at the Giro. He picked a good day: the stage that started at Madonna di Campaglio. The day Pantani of Pantani's downfall. For Verbruggen, this was "the hardest blow that cycling has had to undergo this year." That was saying something. 1999 had not been a good year so far and really could have done without the leader of the Giro being chucked off the race within spitting distance of the finish.

In 1999, cycling was still reeling from the previous year's Festina affaire, which had somehow taken so many by surprise and left them expressing their shock that there was a serious doping problem in cycling. Part of the fallout from Festina was that the media really began shaking the skeletons in cycling's cupboard. We learned more and more about what had really been going on in cycling over the previous few years.

Rattling bones is bad enough, but some former dopers just didn't seem to be singing from the UCI's approved hymn sheet of a new, clean cycling. Take, for instance, Francesco Moser, who finally admitted that his 1984 Hour record has been built on blood doping. His views on doping can't have pleased many in the UCI's HQ: "We'll have to live with doping. Pure cycling is just an illusion. There comes a stage when a rider must be told the effects of a medicine. Then if he wants to, let him take it."

But Moser wasn't the only one questioning the point of going after doping. Juan-Antonio Samaranch, the IOC president, seemed to want to redefine doping itself: " We really must produce an exact definition of doping. The existing list of what are labelled dope products should be drastically reduced. In my view, nothing which does not impair the health of an athlete should be called dope."

Maybe the sport could have lived with those two, if they were isolated incidents. Moser was a dinosaur and Samaranch was ... well Samaranch was Samaranch and everyone knew that he was a bit of a joke. But, inside the peloton, it was clear that not much had changed since the previous year.

Shortly after Paris-Nice - where Rabobank had dominated la course au soleil in a fashion reminiscent of Sean Kelly's Sem squad in 1983 - Jean-Cyril Robin had told a French newspaper that there was now a peloton à deux vitesses. Robin's comments received the support of Daniel Baal, president of the French cycling federation. As the year progressed, others echoed them.

Robin's comments though didn't receive the support of Verbruggen, who - in a response straight out of the UCI's play-book ('Shoot the messenger') - reprimanded the Frenchman. Verbruggen wasn't the only one to do so. At the Circuit de la Sarthe, one English-speaking rider rebuked Robin during one stage, telling him he shouldn't have said what he said. Zip the lips seemed to be the implication of what Robin was told.

Things got more serious in April, when a Mapei mechanic was caught sending a videocassette filled with amphetamines to Gianni Bugno. Then Frank Vandenbroucke, the new darling of Belgian cycling, followed up his Liège-Bastogne-Liège victory by becoming embroiled in a police raid centred on the famed veterinarian and doping doctor, Bernard Sainz, aka Dr Mabuse. VDB was just one of fifteen riders caught in a sting operation. Richard Virenque was another.

If anyone thought April was the cruellest month and things could only get better, May had surprises aplenty in store. Ivano Fanini's allegations about Marco Pantani and the 1998 Giro hit the headlines, Willy Voet's book hit the shops, and the bombshells the Belgian soigneur was dropping about thirty years in the sport were embarrassing many. Especially Verbruggen, who Voet accused of being personally responsible for helping to cover up a positive test by Laurent Brochard at the 1997 World Championships.

The sport really didn't need the Giro's maglia rosa adding to its problems. If only something wonderful and life-affirming could happen and distract us from all this talk of doping ...

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Bonnie Tyler might have been standing in the wings warming up her lungs, but before the 1999 Tour de France started things weren't looking too good. Der Spiegel were accusing Team Telekom of doping. Meanwhile, some of the teams preparing for the Tour called on the UCI to spend whatever it takes on developing new doping tests, particularly for drugs like PFCs: "These substances, in addition to EPO, significantly changes the physiology of the rider. A few years ago we might have said that doping didn't really alter the hierarchy in the sport. This idea is no longer valid. Riders can now mask pain, tiredness and distort the relativities in the results. The winner is no longer necessarily the best rider but the best prepared. While the measures to detect these drugs are expensive we are prepared to help the UCI to stop the doping."

Gérard Dine, who had helped introduce the French health checks, called for the immediate introduction of a new EPO test being pioneered in Australia: "It's very short notice, but, if the [Tour de France] organisers want, we can do it. Either way, the Australians have told me that this will be used during the Sydney Olympics. They can no longer say that it is impossible. Today, the analytical tools are present. We can once again give credibility to performance." The Société du Tour de France gave Dine their support: "The Tour organisers believe that everything will be done so that anti-doping controls include this new process."

The UCI were not so sure, but promised to put all samples taken on ice, to be tested when the EPO test was approved. We all know what became of that promise. And those samples. Regardless, the UCI still pull the same stunt - and are allowed to get away with pulling the same stunt - by promising the long-term storage of samples that will be subjected to retrospective testing when new tests are perfected.

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Pasquale Bellotti's CSAD team continued with their 'I Do Not Risk My health Programme,' now targeting Italy's Sydney hopefuls. All of Italy's Olympians were required to participate, or face not going to Australia. During 2000, as the Games approached, CSAD's testing started throwing up unusual results. These suggested the widespread use of growth hormone among members of the Italian Olympic squad.

Details of this leaked. Especially when the secretary of CONI, Raffaele Pagnozzi, spoke to the media. But for some reason, when Pagnozzi spoke, he somehow managed to suggest there was just one athlete under suspicion.

Marco Pantani, a member of the squad, immediately denied it was him. By the second half of 2000 Pantani had become the whipping boy of Italian cycling - of all Italian sport - and seemed to be attracting investigations into his performances like a shit magnet. He himself accused CONI's Sandro Donati - head of Research and Development at CONI and nemesis of Francesco Conconoi - of orchestrating a vendetta against him, because of his position against the CSAD tests in the 1999 Giro d'Italia.

Verbruggen gallantly leapt to Pantani's defence: "I cannot accept that a rider like Pantani, who's a symbol of cycling, is made the object of inferences and manoeuvres that can destabilise him," Verbruggen told the media.

Defending Pantani is one thing. Not a very wise thing, you might say, in light of what we now know about the coke habit he had acquired after his fall from grace at Madonna di Campiglio, which somehow never got noticed by the UCI's dope testers. Then again, you might argue that Verburggen was only sticking up for the little guy, doing the right thing, regardless of whether it was popular or profitable.

But then Verbruggen launched an unusually personalised attack: "I begin to wonder how CONI, which is entirely responsible in my eyes, can tolerate among its staff two figures like [Pasquale] Bellotti and [Sandro] Donati."

How responsible CONI was back then depends upon your definition of the word responsible and whether Verbruggen meant dependable or guilty. I know which reading I'd take. CONI - like other Olympic committees and sports feds worldwide - had stopped testing their Olympic athletes in the run up to the Games. You won't find what you're not looking for. CSAD though didn't seem to understand how the game worked. They kept testing.

CONI didn't need to be told by Verbruggen they had a problem with Bellotti. By the end of October 2000 CSAD ceased to exist and the 'I Do Not Risk My Health' programme disappeared. CONI did keep Donati on their payroll. 'Look at us!', CONI were effectively saying, 'We employ the outspoken critic of corruption in sport, Sandro Donati! How could you not trust us?'

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Cycling lurched on. In 2001 we got an EPO test. The UCI giddily declared that "the monster has been vanquished. Success at last!" Hyperbolics. The EPO test is of limited value as the window of opportunity for detecting the presence of the drug is only a few days. The UCI persevered with the H-test, even though everyone knows how easy it is to beat it. All you need is the time. And it's amazing how easy it is to make the time, even today. Even so, it's also amazing how many still get it wrong.

Despite its limited effectiveness, the EPO test encouraged some riders to turn back the clock and resurrect blood transfusions. When these became popular in cycling is not really discussed much. We know about Conconi and Moser in 1984 and we know about the US LA Olympians the same year.

But do you really think that was the beginning and end of it in cycling? It's definitely not the beginning. Moser claimed it was a practice used by Jacques Anquetil and others ("I was not the only one nor the first who used blood transfusions to improve my performance. I was told that Jacques Anquetil had done it and that was well before my time. [...] It was my own blood. And I was not the only rider doing it."). At least one rider from the seventies - Joop Zoetemelk - confessed that he used blood transfusions, in the 1976 Tour.

Transfusions come in two main varieties: transfusing your own blood (autologous transfusion), or transfusing the blood of someone with the same blood type as you (homologous transfusion). The latter is fraught with danger, particularly of contacting diseases like hepatitis. Even so, it was often favoured over autologous transfusions. In fact, so popular was it said to be in some teams that rosters were filled out based on blood types and not riding abilities. Its popularity waned after some bright spark came up with a way of spotting it. The authorities still haven't figured out how to spot autologous transfusions. There is ample evidence that they're still being used.

The H-test has been tweaked somewhat. The upper limit is still 50% for men and 47% for women, but now a result above 47% for men, and a similarly reduced threshold for women, will result in the rider having to submit a urine sample which will be subjected to the EPO test. If you've used EPO in the last three or four days, the trick is now to dilute your blood so your H-count is below the new lower threshold that triggers an automatic EPO test.

In 2007, it response to two bad seasons which had seen Operación Puerto, Floyd Landis, Men in Black and lots more, the UCI finally moved on longitudinal testing, promising the introduction of the bio-passport. From the get go, the UCI over-promised and under-delivered, making it look like they'd been bounced into taking on a task they had not prepared themselves for. Which, maybe, they had, after independent testers took their programmes direct to the teams.

We could have had so much more, so much sooner. If the UCI had really wanted to solve the problem. If the UCI hadn't simply brushed aside men like Guy Brisson and Pasquale Bellotti. Brushed aside anyone who offered solutions which didn't fit the UCI's then agenda. But, hopefully, all of that is the past and the UCI of today is nothing like the organisation it was before. Nothing like it at all.

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Sources: Various books touch on different parts of this story, particularly Matt Rendell's The Death of Marco Pantani.