Operation Aderlass and the Bio Passport

The image of Austrian skier Max Hauke sitting with a blood bag connected to his arm during a police raid at the cross-country skiing world championships in Seefeld, Austria was bad enough for any trypanophobes out there. But behind the sordid image came the question: what about the bio passport, can this not be detected? Now with the reported confessions of Stefan Denifl and Georg Preidler it raises wider questions about the passport…

First a quick walkthrough of the bio-passport procedure that loyal readers might already know. It was a scheme launched in 2008 and monitors various values. In a handy explainer on the UCI website it cost CHF 6.6 million in 2013 (about €6 million in today’s money) to run.

A variety of measures are taken when an athlete is tested and these are all logged into a database and over time a “longitudinal profile” is established. Unlike the binary toxicology testing, where a lab looks for banned substances and it’s positive or negative, the passport looks at changes in levels. Software uses logic and probability algorithms to spot anomalies. Here’s a screenshot of the passport software – from a laboratory presentation that’s no longer online – showing haemoglobin, the off-score, the Abnormal Blood Profile Score and the reticulocyte ratio.

This process is run by the Athlete Passport Management Unit (APMU), is a WADA-funded scheme based in Lausanne, Switzerland. The software alerts if an athlete’s numbers deviate from an established pattern. When this happens an expert reviews the data from the system and has four options:

do nothing because the data look normal to the human eye/brain

recommend the athlete is placed on a list for target testing

alert the athlete that they could be suffering from a serious illness

state improbable natural causes, a likely doping case

In the event of the fourth option, the procedures continue for the APMU. Two more experts evaluate the data and they too pick from the four choices above. All three must review the same data set and only if each concludes that, in the words of WADA’s procedural manuals, “it is highly likely that a prohibited substance or prohibited method had been used and unlikely that it is the result of any other cause” will the case proceed. If this is the case then the APMU creates a dossier with the athlete’s age, gender, sport and a range of other information such as the chain of custody for the samples taken, whether the athlete was at altitude and so on. This file is reviewed and the three experts must concur for an “adverse passport finding” and then an anti-doping organization is notified, typically the UCI in pro cycling.

The UCI contacts the rider to advise them that it is mulling an anti-doping case and includes the APMU dossier with the data, sample custody and more along with the request for the athlete to explain the data in the dossier and their response, or not, is noted.

The short version of all this is that there has to be unanimous agreement that this is highly likely a scenario of doping for the case to proceed, any doubt and it won’t.

Then comes the litigation risk, that opening a case against a rider could collapse and leave lawyers bills to be paid, the potential for damages, the difficulty of taking on a millionaire athlete, and in the event of failure for the loss to establish jurisprudence that chips away at the passport itself. There’s no point opening a borderline case for sake of academic exploration. Robin Parisotto, one of the founders of the UCI’s passport, touched on this in an interview last summer with cyclingtips.

That’s the procedural. Now to the practice and we know the passport can be gamed. Amid all the fallout from the Lance Armstrong’s USADA case was the little-publicised story of Leonardo Bertagnolli’s deposition. An Italian rider, he bounced around teams like Saeco, Androni, Cofidis, Liquigas and Androni and admitted to being a client of banned doping doctor Michele Ferrari. Here is an extract of his deposition to the police [my translation]:

“I don’t remember where Ferrari was for the first time he explained how to do an autotransfusions but I remember how he explained the all the ways to do it, saying to get the blood bags from veterinary channels… …indicating to me that I should extract from 350-500cc depending on my recovery times and goals. He told me to make a knot in the bag and to weigh it on the scales in way to know the weight of the amount just taken out; before inserting the needle to make a knot on the tube then to start the transfusion.”

He said Ferrari advised him to buy a medical-grade refrigerator that would store the blood at a temperature lower than a domestic one but otherwise the lesson from Bertagnolli is that riders were doing blood transfusions in their kitchens and bathrooms: there’s no need for private jets or big medical crews, just a home transfusion kit…. although like any DIY project there’s a risk. Bertagnolli also said Ferrari advised him on the timing, to extract blood just before going to an altitude training camp and then to re-infuse on return, so swings in the values can be attributed to the the training camp rather than a blood bag. Asserting this alone won’t explain away everything but with if the changes in values are small because of so-called “microdosing” then it may not be the slam dunk case prosecutors feel comfortable opening.

None of this makes the passport redundant. The passport does work, only last month Jaime Rosón (pictured beating Nibali and CCC’s Hirt and Großschartner) got a four year ban so it can catch some, it’s bound to deter others and also it may contain some from super-sizing things, today the stories of blood doping and EPO use are about micro dosing and so the gains are more limited. But sport is a winner-takes-all domain where being 1% ahead of your rivals can make you 50% richer than them.

Conclusion

The athlete passport is a tool, a way to track blood values which might signal blood doping but it doesn’t deliver the easy positive or negative results that classic anti-doping tests offer. It’s very useful but no panacea. It takes a lot to trip the system and, going by Bertagnolli’s deposition, since its inception some have been gaming it, going up the edges of what they hope they can get away with. This doesn’t mean the passport is useless, if anything we need more passport: more tests to gather more data and crucially more investigation, an odd value may not be enough to open a prosecution but it should invite more regular testing to the point where the rider in question feels some heat, and it could – ideally – result in other investigative work. But this requires resources that sport doesn’t necessarily have so often it’s the police and judiciary that make the big catches.

With reports of 40 seized blood bags as part of Operation Aderlass (Aderlass is German for bloodletting) in Germany and Austria, and presumably the ability to search bank records, Georg Preidler didn’t wait around and confessed to the media over the weekend that he’d drained off blood. Several skiers have now been caught too and there’s surely more to come. If it’s not a national matter, with two Austrian cyclists implicated it does have a local feel for now and team managers with other Austrians on their roster must be busy seeking reassurance today.