The Radcliffe conundrum – Is the biological passport fit for purpose?

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This week blood has been a big issue. In particular the blood of Paula Radcliffe, Britain’s athletics superstar and marathon world record holder. I imagine most of you have seen some of the coverage.

EPO

This has been a fairly fast moving story today, I have had to scrap the first draft and start again! The latest is that Radcliffe has released three values she claims were those flagged as suspicious.  Her reported ‘OFF-scores’ were 114.86, 109.86 and 109.3. ‘Off-scores’ are calculated with a formula from the concentration of haemoglobin and proportion of new red cells (reticulocytes) [details of that calculation here for those interested].  Her explanations for these fluctuations include training at altitude and less than two hours from exercise to sample collection. The altitude training may have an effect on increasing haemoglobin, which could increase the off-score and according to the World Anti Doping Agency collection guidelines should be recorded on the sample collection form. The two hour stand down after exercise is now mandatory, but was not prior, in the above WADA guidelines.  But can she ever clear her name, if innocent?

These readings don’t fluctuate much do they?

Not a great deal, but there are standard numbers used to flag suspicious samples, following altitude training this is reported to be 111.7 for females, which means only one of Radcliffe’ samples was above that threshold. So – only one case to answer not three? Well not really, as I described in my intro to the passport one test isn’t taken on it’s own.  Each tests is judged against all prior tests and all future ones also. The case of Jonathan Tiernan-Locke (cyclist) showed that a sample can be flagged as suspicious a year later after more data is collected. So, to truly test these numbers you would need a longitudinal history of her ‘off-scores’ to judge how these three fit with the others.

Does that prove anything?

No, the data she released shows one suspicious sample, which she is convinced she has an innocent explanation for. If the rest of the values in her profile are all 110 or so she has no real problems from what I can see. But what do the individual components of her blood show in those samples?  Low reticulocytes can mean the body has turned off it’s natural production of red cells due to blood doping or EPO use. Or they could well be innocently explained. But can she convince everyone it is the latter?

Does the passport work and is it fit for purpose?

Maybe. Maybe not. There are obviously issues with it.  Apparently it is sensitive enough to measure changes through dehydration or altitude, but it has been shown not to be sensitive enough to detect ‘microdosing’ (well illustrated by the Panorama investigation into doping earlier this year and previous work by ‘so-called expert’ Michael Ashenden ((c) Seb Coe 2015)).  Microdosing means taking small doses of a drug or blood product more frequently than the traditional larger once or twice weekly doses.

Is it then not fit for purpose? That will depend on what you think it’s purpose is – to eliminate doping or to limit the extremes?  Does it eliminate doping?  No, it can be worked around as proven, therefor it is not fit for that purpose. Does it eliminate extremes of doping? Possibly so, certainly microdosing blood or EPO is not as dramatic as full doses, but can still have considerable effect.

False positives

In the forensic world it is often said that it is better for a guilty person to go free (what we can call a false negative) than an innocent person to be found guilty (false positive).  To this end the passport may have a problem. If the fluctuations may be such that an innocent person has values that can be read as suspicious you risk getting false positives. An innocent sportsperson could face a career ending ban unnecessarily, either because the panel of experts do not agree with their explanation of the fluctuations or because they do not have a money to fight an often lengthy and expensive legal battle. In forensic terms this is akin to those innocently executed in the US through hair evidence found to be unreliable years later.

So why has she changed her tune on transparency?

We know how Paula was very clear on transparency and antidoping in the past, now she is saying she shouldn’t have to release her data. A colleague put it to me today:


 
I can accept that – she now knows that the tests do not tell the whole picture and wants her data evaluated in private not through public scrutiny. When the passport was first talked of over ten years ago I think there was an expectation that it would be extremely sensitive and selective to doping that it would be the definitive test, as she herself campaigned for. In my opinion she hasn’t handled this case (or her reaction to it) brilliantly but again, that does not make her guilty.

 

To me, if it was shown that Paula Radcliffe had doped, it would rank as a bigger shock (by far) than that of Lance Armstrong because there has been no rumour, innuendo or no ex-employee coming out against her. By a few years into Lance’s career there were already all of these things and people refused to believe them, whereas with Paula nothing. I know it would shock most British athletics fans and would have a massive negative impact in the sport. Let’s hope that it is cleared up though, whichever way it falls. If innocent the last thing Paula deserves is an asterix indicating suspicion hanging over her marathon record from now on.

 

Image linked from ‘http://www.paularadcliffe.com/serialisations-taking-on-the-cheats/

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Dr Tom Bassindale

About Dr Tom Bassindale

Dr Tom Bassindale is a forensic scientist, and the founder of We Are Forensic. He's managed hundreds of forensic toxicology cases, and is an experienced court witness. He has specialist expertise in forensic toxicology and drug testing in sport. Dr B is currently a senior lecturer at Sheffield Hallam University. And yes... he watches CSI.