Tough On Doping, Tough On The Causes Of Doping – Francesco Conconi and the Introduction of the H-test

Blood_mediumIn the third part of an occasional series of pieces looking at some of the attempts to deal with this sport's doping problem, we turn to the Haematocrit test, a solution to doping so useless that even Jean-Marie Leblanc of the Société du Tour de France said of it: "The 50% level is a compromise, the best we can do at this time. It is set there more for the riders' protection than anything else. Guys were going overboard, going up past 60%, and having heart attacks."

Success, they say, has many fathers. Failure, on the other hand, is an orphan. If that's really true, then the UCI's Haematocrit test, introduced in 1997, must have been a rip-roaring success. A group comprising Daniel Baal, Roger Legeay and Jean-Marie Leblanc - collectively the three most powerful men in French cycling - called for the introduction of the blood test in October 1996. The riders themselves - most vocally Gianni Bugno, Claudio Chiappucci, Maurizio Fondriest and Marco Pantani - called for its introduction in November. Hein Verbruggen claimed it was a UCI initiative. But perhaps the man with most title to the claim is Francesco Conconi, head of the Centre for Biomedical Studies Applied to Sport at the University of Ferrara. In June 1996, he wrote to Hein Verbruggen:

"I believe that, while awaiting the possibility of identifying commercial EPO in the urine, the UCI could take other actions. The UCI could prearrange for professionals and amateurs selected at random races to take blood tests for the determination of haematocrit values. Such determination is quick, inexpensive and reliable. I also propose that subjects with haematocrit levels exceeding a certain physiological limit (eg 54%) be considered at risk of thromboembolic accidents and, therefore that they be temporarily excluded from competition. Such exclusion would be considered a health precaution and not a disqualification of the athlete."

Now here's a question worth asking: how come Conconi suddenly felt pushed to come up with a solution to the problem of EPO? The bodies had been piling up on mortuary slabs since the late eighties. The UCI's response to that was to establish a survey group to study the health of riders in Belgium and the Netherlands. (That survey wasn't completed until 2000 and its report didn't appear until the following year.)

More importantly, at the time Conconi suggested the H-test to Verbruggen, he himself was supposed to be looking for an EPO test. Back in 1994, he had approached the Italian Olympic committee, CONI, saying that if they gave him about $150,000 he could develop a test for EPO. Another CONI member, Sandro Donati, doubted the science of Conconi's suggestion - and, because he and Conconi had history, had reason to doubt the use to which Conconi would put any money given to him - and effectively blocked CONI funding him.

Donati and Conconi's history went back to the early-to-mid eighties and Conconi's use of blood doping to boost the performance of Italian Olympic athletes. Donati was largely responsible for the Italian Minister of Health declaring this illegal, a move which - linked to the furore in the US over the blood doping of their cycling team at the LA Olympics - helped push the IOC into banning the practice.

Spurned by CONI, Conconi turned instead to the IOC. Prince Alexandre de Mérode, President of IOC's Medical Committee (he had no medical-related qualification), had made Conconi a member of his Committee. In 1992, Conconi had shown his gratitude, arranging for the University of Ferrara to give De Mérode an honorary degree. In medicine. Finally De Mérode was properly qualified to head the IOC's Medical Committee. (Trivia fans may recall Verbruggen bragging that, in 1981, De Mérode "cited cycling as an example for all the international sports federations, citing the UCI as leading the battle against doping.")

De Mérode smoothed Conconi's path at the IOC and the funding he sought was soon forthcoming. He was to work with a group of twenty-three amateurs, administering EPO to them and measuring its effects. The IOC arranged for him to acquire the EPO he would need from a company in Germany. From this study group, he would be able to come up with a test for EPO. Conconi constantly promised he was on the brink of a breakthrough. The solution to the EPO problem would be ready by the middle of 1996. Then by the end of 1996. Then by early 1997. Then by ... oh you get the message. Mañana.

So if Conconi was being paid to work on an EPO test by the IOC and was promising imminent delivery of such a test, why the work-around solution he suggested to Verbruggen? What was going on in 1996 that might have prompted the need for action?

Well there was the increasing interest being taken by judicial authorities in the use of drugs in professional sport. In 1996, NAS - Italy's Nucleo antisofisticazione, the branch of the Carabinieri dealing with health and hygiene matters - became aware of unusually high sales of EPO in Tuscany in the weeks leading up to the Giro. Somehow they linked this to the race itself. They decided to investigate.

The 1996 race started in Greece, with a prologue in Athens followed by two stages before the race returned to Italy. The plan was for everyone on the Giro to return to Italy by ferry, across the Aegean, landing at the port of Brindisi. NAS decided that that was where they would hit the race and search everyone. When checking the exact details, NAS enquired of CONI when the ferries were due to arrive in Brindisi.

Somehow NAS's plans leaked. (Months later, Ivano Fannini, directeur sportif of Amore e Vita, claimed that an important CONI official decamped to Greece shortly after the NAS phonecall and informed a number of teams of the reception committee awaiting them. Like a lot of Fannni's claims down the years, this was never proven.)

Everyone was aware of the welcoming committee waiting for them in Brindisi, especially when La Gazzetta dello Sport (organisers of the Giro) published details of the proposed raid. For some reason, twelve unmarked team vehicles decided to return to Italy overland, via Montenegro, Albania and Croatia. They could have saved the petrol money - because of the leak, the Brindisi raid was cancelled.

As if having the judicial authorities taking an interest in the use of EPO in the pro peloton wasn't bad enough, Conconi had a rival in the search for an EPO test. In February 1996, Professor Guy Brisson, Director of the Montreal anti-doping laboratory, floated the idea of an EPO test to the UCI. Brisson proposed to the UCI that he should carry out new research on the pro peloton during the Tour de Romandie in May. Key to Brisson's research was proving that blood tests could be carried out on the peloton before competition.

The UCI gave Brisson the go-ahead to carry out his research. Unfortunately, the riders at the Tour de Romandie were unhappy with the idea of anyone looking at their blood and refused to cooperate. In the end, it was agreed that samples would be collected purely for research purposes, and that anonymity would be guaranteed. Brisson was able to carry out his research during the Tour de Suisse in June.

The UCI, in their 2001 document 40 Years Of Fighting Against Doping, said of Brisson's research: "It was the first time that the majority of riders, representing a total of sixteen teams, accepted that scientists took a small amount of their blood to develop a method of detecting exogenous EPO. Unfortunately, this research was not successful."

Not successful? That we'll come back to in due course. But Brisson's research was most definitely not a failure. Before the fourth and seventh stages of the Tour de Suisse, Brisson's researchers had been able to test seventy-seven riders. Those tests revealed an average haematocrit level of 46%. Other research suggested that a level of 42% should have been expected. Brisson's research also showed unusually high levels of iron in some of those tested. Iron tends to be taken in conjunction with EPO to make the drug more work effectively. Most importantly, Brisson proved that it was possible to carry out systematic blood tests immediately preceding competition. This opened up a new avenue in the quest for an EPO test.

However, there was one major problem with this new avenue: Verbruggen opposed blood tests in principle. Speaking in January 1997 he said: "It must be made clear that our anti-drug commission has always been against blood test controls because of ethical problems." At this point, the UCI was trying to pass the buck for dope testing back to teams and away from themselves: "The solution is to make teams responsible for the health of their athletes as any employer would do in relation to his personnel."

Regardless of Verbruggen's view, Conconi must have been under pressure to pull a rabbit from the hat now that others were on the trail of an EPO test. Which might perhaps explain his proposing the H-test to Verbruggen. Suggesting something to the UCI of course did not mean it was going to happen. In 1994 Bruno Roussel, the directeur sportif of Festina, in an interview in La Gazzetta dello Sport, publicly called on Verbruggen to do something about the rising problem of EPO abuse. He suggested that, if nothing was done, it was a choice between letting his team use EPO or losing his sponsorship. (Festina had actually made the choice the previous year. And we know what they chose.)

1994 had seen a brief furore over EPO, when Michele Ferrari told a group of French and Italian cycling journalists that EPO was no more dangerous than orange juice. In both cases, he said, it was abuse that was the danger, not the substance itself. (And he was right. Too much orange juice can give you the trots. Too much EPO can give you a heart attack.) Verbruggen had surfed that storm by saying Ferrari must have been misquoted, that it was a case of rubbish journalism. He pointed to the number of doping tests carried out and the small number of positives they produced. (Even though there was no test for EPO.) There being no problem, Verbruggen ignored Roussel's request.

So what else was going on in 1996 that might have helped push the UCI into moving on an issue which, up to then, hadn't been an issue?

Well there was the intervention of Daniel Baal, Roger Legeay and Jean-Marie Leblanc. In an open letter to Verbruggen and the French Minister for Sport, Guy Drut, published in L'Equipe in October 1996, they had called for the introduction of a blood test. "If it is confirmed that blood tests are a more effective means of detection," they wrote, "then we must change the legislation immediately. We must stop the development of forbidden practices which also put athletes' health at risk and sport under suspicion." What promoted their call? Well it was just the way the sport was getting. There was, as you can seen, a lot of stuff going on in 1996.

There were serious things, like one leading cyclist succumbing to cancer. There were silly little things, like at the Tour, with Bjarne Riis on Hautacam. For years the sport had got used to non-climbers soaring up the hills, but it was the way in which Riis taunted the peloton that day before riding away from them that left some journalists reaching for euphemisms.

At stage races, some of those same journalists were getting increasingly curious about riders keeping their bikes in their rooms, especially when they heard what sounded like riders on rollers in the middle of the night. L'Equipe journalists were getting very curious and thought to be working on a major exposé.

There was Graeme Obree who, shortly before the Baal / Legeay / Leblanc letter appeared, had told L'Equipe that he was considering quitting because he couldn't keep up with riders on EPO. He changed his mind after De Mérode declared that a test for EPO would be implemented in time for the 1998 Winter Olympics. "Despite the fact we can now detect EPO," De Mérode told the world, "the war against the drug cheats is far from being won."

At the Vuelta a España the previous month, Manolo Saiz's ONCE squad had come down with a dose of bad fish. The year before, at the 1995 Vuelta, a couple of Danish journalists, Olav Scannig and Niels Christian Jung (who was himself a soigneur with Gewiss at the time), had searched the waste left by the ONCE squad in Orense. They recovered syringes and empty ampoules, which they had tested. The ampoules showed traces of EPO.

That was the type of year it was. From the aborted raid on the Giro in May through the bad fish at the Vuelta in September, those closest to the sport could see that things were spiralling out of control. They could sense the gathering storm.

* * * * *

The storm broke shortly after the Baal / Legeay / Leblanc letter appeared. Around the same time La Gazetta dello Sport was publishing a series of articles on doping. For one of those articles La Gazzetta's journalists spoke to a former doctor to the Italian national women's team, Flavio Alessandri. He mentioned to them that he had collaborated with Sandro Donati on a report for CONI, a survey about drug abuse in Italian cycling. Alessandri told La Gazzetta's journalists that Donati's report had been suppressed.

The journalists followed up this claim, contacting Donati, who confirmed the existence of the report and told them to contact the president of CONI, Mario Pescante. Pescante denied the report's existence. An Italian politician, Walter Veltroni, decided to poke his nose into the mystery. Pescante suddenly remembered that there actually was such a report, and even found a copy of it. This was passed on to an examining magistrate.

Five days after Alessandri revealed its existence to La Gazzetta, four days after Pescante denied its existence, three days after Veltroni called his bluff, two days after Pescante's mature reflection, a day after the magistrate received it, Donati's report was published. That was October 30, 1996. Don't let that apparent speed fool you. Donati's report had been delivered to CONI in February 1994.

The report - a brief document, just fourteen pages - had been written after interviews with a small number of riders, doctors and directeurs sportifs. Thirty or so people in all. All interviewees were granted anonymity. It was the only way to beat the law of omertà. In his report, Donati didn't mince his words:

"The abuse has spiralled out of control. In some of the races, they are now climbing hills at speeds they used to reach on the flat! And why? Because the majority are pumped to the gills with shit like EPO, HGH and testosterone. For the good of sport, it is imperative we act immediately to stamp this out."

Based on the testimonies given to him, Donati claimed that the use of EPO was rife and rising within the Italian peloton. He wrote of how the EPO and other drugs being used by riders were largely being sourced on the black-market, which, in Italy, suggested Mafia involvement. He also wrote of how easy it was to obtain EPO from some pharmacists, particularly in Switzerland and - perhaps you'll find this odd - Vatican City. All you needed was a prescription, and getting a doctor to write one of them has never been much of a challenge. The most damning claim in the report was that Francesco Conconi - rector of the University of Ferrara, a member of CONI, a member of the UCI's Medical Commission and the man tasked by the IOC with developing a test for EPO - was responsible for introducing EPO to the sport in Italy.

* * * * *

Conconi may have been the man most responsible for EPO's use in the Italian peloton. But he wasn't the man who introduced it into sport. The first spate of EPO-related deaths - across a range of sports, including cycling but also orienteering and skiing - had occurred in the Netherlands, Belgium, Germany and Sweden. Bert Oosterbosch, who you'll recall from Willy Voet's Breaking The Chain, died of a heart attack in 1989. He was thirty-two. Johannes Draaijer, a rider with PDM, died in his sleep the following year. He was twenty-seven. In a TV interview his wife said her husband took EPO and that she hoped his death would serve as a warning to others. It didn't. The death toll rose.

In America, Les Earnest, a director of the US cycling fed, became aware of EPO and of its potential benefits to cycling in 1988. Earnest had criticised the used of blood doping by US cyclists at the LA Olympics in 1984. Faced with EPO, he thought it might be a safer alternative to blood doping. He suggested the fed set up a study group to look into it. The fed turned didn't agree with him.

Perhaps most worryingly, a Danish physician, Søren Kragbak, claimed that in 1989 a Swedish medical company had contacted the Danish cycling fed requesting to be allowed carry out secret EPO tests with Danish cyclists. The Danes turned down the request. Medical companies pimping a product that was designed to treat renal problems might help explain how come so many sports physicians suddenly became aware of the benefits of EPO. By 1991 the sporting uses of EPO were no secret, with medical journals publishing research by Scandinavian and Dutch doctors.

This is not to suggest that Conconi was without blame. He wasn't, and we'll come back to that momentarily. But not all the sins of Gen-EPO should be laid at his door. He was just one among many. The genie was out of the bottle.

* * * * *

A week after the publication of Donati's report, a group of prominent Italian riders, which included Gianni Bugno, Claudio Chiappucci, Maurizio Fondriest and Marco Pantani, called for the introduction of blood testing. It's probably just a coincidence that Bugno, Chiapucci, Fondriest and Pantani were all clients of the University of Ferrara, home to Francesco Conconi.

Then came a series of articles in L'Equipe in January 1997, the exposé the paper's journalists had been working on for some months. It started with the story of the suppression of Donati's report and an interview with Donati himself.

Another article was based on the testimony of two riders, Gilles Delion and Nicolas Aubier, who talked of the difficulty of trying to ride clean in a dirty peloton. Delion was a rarity in the peloton, a rider most everyone believed was clean. Rarely did he receive the rewards he deserved. Aubier was a twenty-four year old who, after four years in the pro ranks, was chucking in the towel. He explained his reasons to L'Equipe's Pierre Ballester:

"One of the biggest disappointments I will take from my carer is the wait-and-see attitude that has been adopted by officials. Why aren't they doing something about it. Why haven't they made every possible effort to eliminate this cancer? It's as if the riders are entirely disposable; wheel them in for the show and then discard them. It's time to put a stop to the massacre."

Verbruggen was asked for his take on L'Equipe's articles: "I will probably disappoint you, but I was not at all impressed, not at all, with the accounts given by riders like Delion and Obree. What we are dealing with here is guys at the end of their career who can no longer hang on. I found it cowardly, there is no other word."

A week after L'Equipe's articles, the UCI formally voted to introduce blood tests. Unfortunately for Conconi, his proposal of a 54% limit was passed over in favour of a 50% limit (47% for women). The first tests were carried out at Paris-Nice. One of the first riders to be tested was Mauro Santaromita of MG TechnoGym. He failed. The Gods of cycling must have a sense of humour: Santaromita was a client of the University of Ferrara. (Erwan Menthour and Luca Colombo were the other two riders busted by the H-test at Paris-Nice.)

If the introduction of the H-test was meant to forestall judicial inquiries into the use of EPO in the pro peloton, it failed. As part of an investigation involving gyms in the cities of Bari, Brindisi and Trento, NAS hit the 1997 Giro d'Italia. A phone-tap had intercepted a call to a sports supplements company, looking for steroids. NAS linked the caller to the Giro.

This time NAS had the element of surprise. They raided the hotel of MG TechnoGym. Afterwards, the team's directeur sportif, Giancarlo Ferretti, spoke to the Italian news agency ANSA: "In thirty years of cycling this is the first time I've ever heard of this kind of thing. With urine tests, blood tests and now checks by the NAS, sport has become so hard.'' A team spokesman, Cesare Paolini, initially said nothing was found.

Later it was revealed that NAS had actually found doping products, including EPO and Synachten. Ferretti told them the products were for his personal use. To gain more sexual strength, he told NAS. Later, the teams' soigneur, Luigi Sarti, admitted that the drugs were intended for use by the team's riders. They included Michele Bartoli, Paolo Bettini and Gilberto Simoni. No attempt was made to turf MG TechnoGym off the Giro. The Italian cycling fed, the FCI, suspended Ferretti for one month. Sarti got nine months in the sin bin. At the end of the season, MG TechnoGym withdrew their sponsorship.

A few other riders failed the H-test in 1997. One was Claudio Chiappucci, just before the start of the Giro, meaning he missed the race. He, you'll remember, was one of the riders who called for the introduction of the test. And, like Santaromita, was a client of the University of Ferrara.

Now that might lead you to believing that the people at Ferrara were just a bunch of cowboys. Snake oil salesmen. But don't forget one of their biggest successes, away back in 1984, when, through the appliance of science and a few bags of recycled blood, they helped Francesco Moser beat Eddy Merckx's Hour record twice in one weekend.

Or look to their rôle in the dominance of Italian teams in the early nineties. Let's go back to 1994 again. That was the year of the one-two-three at Flèche-Wallone achieved by Gewiss riders Moreno Argentin, Giorgio Furlan and Evgeni Berzin. Gewiss were flying in the Spring of 1994. Furlan had won Tirreno-Adriatico, with Berzin just behind him in second. Furlan added Milan-San Remo and the Criterium International to his tally. Three days before their podium lock-out at the Flèche he was on the bottom step at Liège-Bastogne-Liège, with Berzin taking the victory. Their Spring form continued on into the Summer: Berzin won the Giro, Piotr Ugrumov finished second in the Tour. Even into the Autumn they were winning, with Vladislav Bobrik taking the Giro di Lombardia. The Gewiss squad were clients of the University of Ferrara.

To give some perspective on how much esteem there was for Conconi's clan in Ferrara - which, over the years, is said to have included other well known doctors, such as Luigi Cecchini (a claim which he denies), Michele Ferrari, Aldo Sassi and Carlos Santuccione - look at what happened in Banesto when Sabino Padilla left the team. Francesco Conconi had worked with Miguel Induráin in the eighties and it was to Italy that José Miguel Echávarri, Induráin's directeur sportif, looked after Padilla left, giving the people at Ferrara this glowing reference:

"I am seeking collaboration with [Ilario] Casoni, [Nicola] Alfieri and [Marcello] Lodi [another three of Conconi's protégés at Ferrara] at least for a team get together which will be held in Palma di Majorca in February [1996]. There will hopefully be some tests in Milan followed by a week at Pamplona. At the present time the Italians lead the world in sports medicine and training techniques. A void has been left by Sabino Padilla, the medic who has left Banesto after so many years to take a position with the football club Atletico Bilbao. Sabino, who was Induráin's personal trainer, left without even mapping out the [1996] season. So we have to find a new medic, either in Spain or in Italy, but probably from the University of Ferrara. As of now Casoni, Alfieri and Lodi are being considered as our consultants."

So, again, why had Conconi proposed the H-test in 1996? Was it at the behest of the UCI, who needed a fig-leaf behind which they could hide? Could it have been because the competitive advantage he had been able to offer Italian cyclists had been wiped out by most of the rest of the peloton turning to EPO too? Was it because others - particularly Cecchini, Ferrari and Santuccione - were selling their services to the highest bidders, regardless of nationality? Who really knows. All we know is it happened. And what was going on in the sport at the time it happened.

* * * * *

Maybe this would be a good time to bring back in those NAS officers who planned to raid the Giro in Brindisi in 1996. They took their defeat there on the chin and got on with their inquiry. In 1998, that resulted in a raid on the University of Ferrara, which saw various computer files being seized. Files which painted a picture of a state-sponsored doping programme that benefited, among others, the upper echelons of the Italian peloton. The twenty-three amateurs Conconi was supposed to be using in his quest for an EPO test were not amateurs at all. Some of them were members of the Carrera squad.

Conconi escaped legal censure, thanks to Italy's statute of limitations, but the judge, Franca Oliva, still delivered a stinging judgement which left little doubt in the minds of anyone as to what Conconi and his colleagues had been doing at Ferrara. Anyone, that is, apart from the UCI. Even after Oliva's denouncement of Conconi, Verbruggen was still proud to have him as a president of the UCI's Medical Commission.

As damning as Oliva's denouncement of him was, there is one good thing you can say about Conconi: when he was administering EPO, he was at least administering a drug which he was not afraid to use himself. Eugenio Capodacqua tells a story of a 1993 hill climb he took part in, a time trial up the Stelvio. Two others racing that day were Verbruggen and Conconi. Conconi flew up the Stelvio. Years later, when Capodacqua got access to the Ferrara files, he found Conconi's name listed in them, registering a H-count of 57%, above the limit even he suggested put riders at risk of thromboembolic accidents.

This might also be a good time to bring Guy Brisson back into this. You remember him, the Canadian doctor who was trying to develop an EPO test in 1996? When the shit hit the fan during the 1998 Tour, Brisson suddenly found himself popular. Journalists finally wanted to know what had come of his 1996 research. His answer was not very comforting.

For a start, he disputed the UCI's claim that his research was unsuccessful, claiming he had actually come up with a test for EPO. It was reviewed and published in the scientific journal Nature. The IOC and the UCI, however, didn't want to know about it, he told the Toronto Star, claiming it wouldn't bear legal scrutiny:

"At several meetings, officials from the UCI and IOC expressed their fear that the test's indirectness made it vulnerable to legal challenge by millionaire athletes. It was too easy for them to say that because then nobody is accused of using EPO. Everybody knew what was going on for years. But the arguments they made against the test made it clear they didn't really want to catch athletes. It's always going to be the same if your responsibility is to both promote a sport and be a watchdog."

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Next time: beating the H-test, another bad year and what became of a possible means of improving the H-test's effectiveness.

Sources: Various books touch on different parts of this story, particularly Matt Rendell's The Death of Marco Pantani; Paul Kimmage's Rough Ride; and David Walsh's From Lance to Landis. Where possible, I've pointed to online sources.