Kreuziger’s public defence raises further questions about doping case

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The denial had echoes of another rider who also previously worked with Michele Ferrari: Lance Armstrong.

On Saturday Roman Kreuziger released a statement, which began with these words.

“My name is Roman Kreuziger. I am a professional cyclist. I have never tested positive for doping.”

The statement went on to proclaim his innocence of the biological passport manipulations he is accused of by the UCI, but that opening section was redflagged by many on Twitter.

They wanted to know why Kreuziger had used the ‘never tested positive’ line oft quoted by Armstrong and other doping riders, rather than a clear statement that he had never used performance enhancing drugs.

Challenged about this on Twitter, Kreuziger or his representatives later amended the website statement to read: “I have never doped and never tested positive for doping.”

The shortcoming was a shot in the foot, though.

Questions are also being asked of the blood profiles Kreuziger put online to try to show he was a clean rider. These were published in response to suspected periods of blood doping.

He was first contacted by the UCI about this matter on June 28 2013 and provided the UCI with an expert analysis of those samples in October of last year. This explanation was rejected on May 30 2014.

He had a hearing before the Czech Olympic Committee on August 20 of this year; on September 22 that committee said it had decided to clear him. The UCI was not happy and appealed to the Court of Arbitration for Sport (CAS) on October 23.

No date has been announced as yet for that hearing, but the next round in the rider’s fight will happen sooner rather than later.

Blood levels raise questions:

The periods of alleged abnormalities run from March 2011 until August 2011 and from April 2012 until the end of the 2012 Giro d’Italia.

These are all included in the table of blood values published by Kreuziger, which runs from April 24 2008 until April 9 2013.

Further data is also included in a number of reports printed on his website, making it possible to determine values such as haematocrit [percentage of red blood cells] and reticulocytes [percentage of immature blood cells].

Haematocrit tends to rise after prolonged exposure to altitude, to the banned blood booster EPO and following an illegal blood transfusion.

Reticulocytes normally drop when the body experiences an increase in red blood cells, although microdosing EPO can fend off this fall or even cause an increase.

Examining the periods highlighted by the UCI as being suspect, a pattern is shown whereby the rider’s haematocrit levels behave differently than might be expected. Looking at the 2011 Giro d’Italia, which ran from May 7 to 29, tests taken just before the start, during the race and just over a week after the finish show an unusual pattern.

The values are 46.9 percent, 46.5, 43 and 48.4, as taken on May 5 [pre-race], May 20 [day of stage 13], May 29 [stage 21] and June 11 [post-race]. The reticulocytes for the same period are 1.52, 1.62, 1.78 and 1.66, all considerably higher than the average expected value of one percent.

That year’s Tour de France [July 2 – 24] is another period highlighted by the UCI as being of concern. Kreuziger’s haematocrit levels were 44, 44, 44.3 and 47.6 for June 30 [pre-race], July 15 [stage 13], July 20 [stage 17] and August 1 [post race], while the corresponding reticulocyte readings were 1.31, 1.45, 1.77 and 1.6.

The third stage race which falls within the UCI’s period of concern is the 2012 Giro d’Italia [May 5 – 22]. He did a pre-race test on May 3, then others on May 14 [stage 9], May 20 [stage 15] and May 24 [stage 18].

His haematocrit levels were 45.1, 43.2, 44.8 and 48.1 respectively, while his reticulocyte levels were 1.45, 1.44, 1.52 and 1.4.
Several points of note can be made about these levels. Firstly, Kreuziger displayed a jump in haematocrit either just after a three week Grand Tour or, in the case of the 2012 Giro d’Italia, actually during the race. His reticulocyte levels all appear relatively high.

Most studies suggest that haematocrit should fall over the course of a three week race as the body becomes more fatigued.

During the 2012 Giro, the substantial jump in haematocrit on stage 18 coincided with a drop in reticulocytes, and occurred one day after he cracked and lost a lot of time. Interestingly, though, the change in his blood parameters came one day before he rode extremely strongly and won stage 19.

In its CAS appeal, the UCI will presumably seek to show that Kreuziger underwent a blood transfusion. This would explain the jump in haematocrit, the drop in reticulocytes and also the increase in performance.

Kreuziger seeks to explain away blood fluctuations due to his claims that he has suffered from hypothyroidism [a sluggish thyroid gland] plus the resulting use of hormone replacement therapy L-Thyroxine.

In a statement on his website, he claims his innocence is shown because he did not cross certain thresholds. “I have never exceeded the basal values and did not even approach these values,” he writes.

“The Arbitration Committee of the Czech Olympic Committee cleared me of any wrongdoing in October of this year. The UCI have appealed to the Court of Arbitration for Sport in Lausanne and I am still threatened with a four year ban and a high fine.

“I condemn doping and cheating in sport. I consider the biological passport to be an excellent tool. However, clear rules for its use must be set out otherwise it is useless and can be used to eliminate anyone. Rules cannot be changed during a game. And that is what is happening now. What purpose do the basal values serve if mere suppositions are used to determine guilt?”

However arguing that basal values need to be crossed in order to trigger a biological passport procedure is misleading and inaccurate. The biological passport looks for unusual patterns over time, with the UCI obviously feeling that the fluctuations highlighted are sufficient to pursue a doping case.

“The odd part about it is that his reticulocyte count is elevated”

Dr Mike Puchowicz is a sports medicine physician for the Arizona State University Health Services, author of the Veloclinic blog and has long analysed sports performances from an anti-doping context. He is involved in the new Clean Protocol project which seeks to fight drug use in triathlon competition.

He spoke to CyclingTips about Kreuziger’s biopassport, and said that he had concerns. For him, the reticulocyte pattern is the primary warning flag.

“The odd part about it is that his reticulocyte count is elevated,” he said. “When you are talking about 2012, the question is what the hell was he using? If he had a blood transfusion [in the final week of the Giro, thus explaining the rise to a haematocrit of 48.1], it should have knocked his reticulocyte count down and it didn’t.

“I was expecting to see something a lot like Armstrong’s case, where the haemoglobin stays higher than expected, and then you get a reticulocyte count that you would expect from a micro-dose, a masking dose. But in Kreuziger’s case, the reticulocyte is elevated. So what was he using and why couldn’t they pick it up in retrospective samples?”

Puchowicz points out that Thomas Dekker was nabbed with such retrospective testing, but that Kreuziger doesn’t seem to have been caught in this regard. This troubles him as it suggests that there may be a product in use that the labs don’t have a test for.

“There are several months over the course of two years where he has got this very elevated reticulocyte count. All signs kind of point to doping from that perspective. But for me it is disturbing in terms of if it is doping, then look how bad the direct tests are. It points to it being something undetectable.”

Puchowicz also has questions about the rise in blood levels seen either right after a Grand Tour or, in the case of the 2012 Giro, in the final week of the race.

He points out that Kreuziger’s defence team cite a research paper by Corsetti based on the Liquigas-Cannondale riders in the 2011 Giro. This shows blood levels falling during the race but, in the case of four of the nine riders, a rise of sorts was seen before the end of the Grand Tour.

Puchowicz states that it is difficult to take the Corsetti paper as a guarantee of how the body responds, pointing out that the riders concerned could potentially have been doping themselves. He said that unless it is verifiable that the riders were all clean, that the study is a flawed one.

Lotto-Belisol rider Greg Henderson appears to believe a fall in haemoglobin is typical and expected. “I started 2012 tdf [Tour de France – ed.] at 46 and finished at 39 hct,” he said, then added somewhat sarcastically. “Would be nice to inc [increase] haematocrit during a GT.”

Could thyroid medication explain away suspicious blood readings?

A major part of Kreuziger’s defence is based on the thyroid medication he states he was taking. He said that his hypothyroidism condition was made clear to the UCI and that he had permission to use medication to treat it.

Puchowicz accepts that the medication could have caused some changes, but doesn’t appear to think this is sufficient reason to explain the fluctuating blood values plus the elevated reticulocyte count.

“The general gist is that, I guess from the perspective of his story about this being caused by the hypothyroidism and the treatment, I agree with the UCI on that one,” he said.

“I don’t really see that argument being very compelling because the study that his experts pointed to, they are talking about a change in reticulocyte count in terms of treating hypothyroidism. However that’s going from complete lack of thyroid function to being fully treated.

“In that study, you just see the subjects going from a low reticulocyte count to a normal one, so it is just normalizing the reticulocyte count.

“In Kreuziger’s case, what you are doing is going from a normal value to a very elevated one, and a persistently elevated one. It is not like he ever went from zero thyroid function to full blown treatment. Basically what you see in the labs is that he was being treated, maybe at times inadequately, but the jumps are going from 50 to 75 to 100 on his dosing. So it is not like he went from zero to 100, it was just incremental steps.

“In that case, I don’t find the thyroid issue very convincing. It can certainly have effects on the biological parameters, but I don’t find it is the explanation for his reticulocyte count.”

The Court of Arbitration for Sport will weigh up the various arguments and ultimately make the decision that will either clear Kreuziger or seal his fate. If he is cleared, he will be able to return to competition with the Tinkoff Saxo team. If he is found guilty of doping, however, he will face a lengthy ban and will also have to pay a large fine.

At this point in time the UCI and the Cycling Anti Doping Foundation are following their own rules about saying very little. CyclingTips sought comment from one of the UCI’s biological passport experts Robin Parisotto, but the Australian said that he was unable to comment on the case.

Kreuziger is taking a very different approach. He is making his arguments in public, using emotion to try to fight his corner.

“The proceedings have dragged on unbearably. I was forced to wait without reason for many long months for a statement from the UCI,” he said. “This year I was unable to compete in the Tour de France or other subsequent races. My career will soon be over, and dragging out this case could destroy it.

“I don’t ask for sympathy or leniency. I have always respected the principles of fair play, and as a competitor at two Olympic Games I respect the principles of the Olympic Charter. Today I find myself part of an absurd theatre, but tomorrow it could happen to any other athlete. I want a just process, I want clear rules and I want fair treatment. Keep your fingers crossed for me.”

For Puchowicz, this approach simply represents the rider trying to maintain support.

“It doesn’t surprise me from the perspective that he is really just playing to his fans,” he said. “He is kind of making a Horner move, saying ‘I have got nothing to hide, and my fans will back me.’ And I am sure they have, they will say ‘look, it is all there, and he has explained it.’”

That may suffice for his fans, but others who study his haematocrit and reticulocyte levels may come away with more questions than answers.

Also see: Anti-doping expert Parisotto on inherent delays in bio-passport system

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