TUE-ed tests and Cortisone

TUE-ed tests and Cortisone

Posted in the Floyd Landis Forum

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TrustButVerify

Santa Rosa, CA

#1 Sep 16, 2006
A few things that came out in the last week seem to have gone underexplored to me. We learned that:

(a) There were twelve other AAFs cleared on TUEs;
(b) Some of the AAFs cleared were for cortisone.
(c) Landis hasn't gotten any resuls from any of the other tests he was given on the tour.

We /think/ that if a rider is cleared on a TUE, he isn't informed about it.

Thus, we don't know if any of the other tests for Landis were positive for the cortisone he had a TUE to use.

For the tests that were positive on cortisone, we don't know if there were CIR tests done, or if only screening tests were done.(For that matter, we still don't know if CIR was done on Landis's A sample, or only the B).

If the cortisone test was any good, Landis *should* have been positive every time he was tested. I think I've had a discussion somewhere where this came up, and this point was poo-pooed as an example of how the tests are geared towards false-negatives, and failure to flag Floyd here didn't show anything interesting. This doesn't make much sense to me. Floyd was getting enough to make a horse fly, so if the test was going to detect anyone, it should have gotten Floyd.

There seems to be two broad cases,(1) the cortisone test works; (2) it doesn't. We don't know which is the case.

Could this be resolved by Landis waiving his confidentiality rights and insisting that if he was an AAF/TUE on other tests, it be revealed? Would the UCI (who would have TUE-ed the AAF) cooperate, or hide the results?

If UCI cooperates and the test works, it should be that Landis was TUE-ed for all his tests. But the test on S17 is not reported to have turned up cortisone by any account. What would that say about whether they tested the right sample?

The alternatives are that Floyd was none of the other cortisone AAFs, or that he had some, but not all of his tests were AAFed for it. If none, what does that say about the cortisone test? If some, it seems that either the cortisone test is not repeatably correct, or that there were pervasive chain-of-custody sample identification problems.

Am I missing something? If we can't find out how many times Landis was TUE-ed for cortisone, who is hiding something, and why?

TBV http://trustbut.blogspot.com for Landis news, research, and comment.
TrustButVerify

Santa Rosa, CA

#2 Sep 16, 2006
By the way, does anyone know a decent way to search these forums? I don't find the 'search topix' field on the top is of much use.

TBV
Wayne

United States

#3 Sep 16, 2006
TrustButVerify wrote:
A few things that came out in the last week seem to have gone underexplored to me. We learned that:
(a) There were twelve other AAFs cleared on TUEs;
(b) Some of the AAFs cleared were for cortisone.
(c) Landis hasn't gotten any resuls from any of the other tests he was given on the tour.

Am I missing something? If we can't find out how many times Landis was TUE-ed for cortisone, who is hiding something, and why?
TBV http://trustbut.blogspot.com for Landis news, research, and comment.
Your points are well taken...frankly I am surprised that the TdF test data wasn't made publically available. What is this, some kind of star-chamber procedure???

In addition to your questions, I would like to know:

1. How many times was Floyd tested specifically for T/E ratio...and on what stages?

2. What other competitors were tested specifically for T/E ratio ..and on what stages?

From what I have seen, we ordinary peons ( well, at least this peon ) are unlikely to get many answers to the most obvious questions.

---Salem, Oregon---
Slovenian Princess

Hotchkiss, CO

#4 Sep 16, 2006
TrustButVerify wrote:
A few things that came out in the last week seem to have gone underexplored to me. We learned that:
(a) There were twelve other AAFs cleared on TUEs;
(b) Some of the AAFs cleared were for cortisone.
(c) Landis hasn't gotten any resuls from any of the other tests he was given on the tour.
We /think/ that if a rider is cleared on a TUE, he isn't informed about it.
Thus, we don't know if any of the other tests for Landis were positive for the cortisone he had a TUE to use.
For the tests that were positive on cortisone, we don't know if there were CIR tests done, or if only screening tests were done.(For that matter, we still don't know if CIR was done on Landis's A sample, or only the B).
If the cortisone test was any good, Landis *should* have been positive every time he was tested. I think I've had a discussion somewhere where this came up, and this point was poo-pooed as an example of how the tests are geared towards false-negatives, and failure to flag Floyd here didn't show anything interesting. This doesn't make much sense to me. Floyd was getting enough to make a horse fly, so if the test was going to detect anyone, it should have gotten Floyd.
There seems to be two broad cases,(1) the cortisone test works; (2) it doesn't. We don't know which is the case.
Could this be resolved by Landis waiving his confidentiality rights and insisting that if he was an AAF/TUE on other tests, it be revealed? Would the UCI (who would have TUE-ed the AAF) cooperate, or hide the results?
If UCI cooperates and the test works, it should be that Landis was TUE-ed for all his tests. But the test on S17 is not reported to have turned up cortisone by any account. What would that say about whether they tested the right sample?
The alternatives are that Floyd was none of the other cortisone AAFs, or that he had some, but not all of his tests were AAFed for it. If none, what does that say about the cortisone test? If some, it seems that either the cortisone test is not repeatably correct, or that there were pervasive chain-of-custody sample identification problems.
Am I missing something? If we can't find out how many times Landis was TUE-ed for cortisone, who is hiding something, and why?
TBV http://trustbut.blogspot.com for Landis news, research, and comment.
about the cortisone showing only on the stage 17 test,
if he was masking/dehydrated/drinking too much, and something was amiss for that one stage, would that explain his levels? what if it is just remnants of the cortisone, and the dehyrdration/bonking upset the balance in his system...then it would not necessarily show up on the other tests.
by the way, if they are masking, is it a daily updated (kind of like the pill, they have to take it daily and if they miss one day there is a window of opportunity) use or is it only utilized when they use the performance enhancer of choice?
the last question, why wouldn't landis have a
Zeek

Milton, WA

#5 Sep 16, 2006
TBV
Good points all. It only adds to my belief that these tests dont reliably test for what they are proported to measure. I do not think the administration of epitestosterone (masking) should do anything to a measurement of cortisone.
TrustButVerify

Santa Rosa, CA

#6 Sep 16, 2006
Test data isn't made available because it is suppoosed to be confidential until a B sample is confirmed. We have seen that the powers are rather parsimonious with even statistical data that would reveal anything. That's why I'm wondering if Landis waiving confidentiality could result in determining if he was one of the TUE-ed riders. If he does that, and it is still not released, then I start to think that somebody is hiding something. But I'm a known transparency nut, so take that with a grain of salt.

My understanding is that Landis had 8 total tests during the tour, all of which were urine and should have gone through the full screening barrage for T/E and cortisone. Everyone selected for testing on a stage would get the same screening of the A sample.

What I've heard is that none of these tests are supposed to be affected by dehydration (they can correct for it); and that shouldn't have been an issue on S17 because he was plenty hydrated.

The 'masking' theory might be that he was dehydrated after S16, and that was factored incorrectly into that nights administration of E masking agent. I have no idea if that is sensible. There aren't many peer-reviewed papers available describing how to do doping programs using masking agents :-).

TBV http://trustbut.blogspot.com for Landis news, research, and comment.
Slovenian Princess

Hotchkiss, CO

#7 Sep 16, 2006
TrustButVerify wrote:
There aren't many peer-reviewed papers available describing how to do doping programs using masking agents
go figure...
Will

Baltimore, MD

#8 Sep 16, 2006
TrustButVerify wrote:
...My understanding is that Landis had 8 total tests during the tour, all of which were urine....
In the words of Ronald Reagan, "There you go again!"...the LAST thing we need at this point is ANOTHER speculative conspiracy theory.

And I seem to recall Landis claiming that some of his TdF tests were BLOOD tests, so which is correct -- 8 all-urine tests or some urine and some blood tests? Why not spend time more productively by nailing down this basic fact before spinning another conspiracy?
TrustButVerify

Santa Rosa, CA

#9 Sep 16, 2006
I don't remember hearing he had blood tests. It doesn't seem like it affects the immediate topic one way or another. I'd be delighted to know what samples were conducted after which stages.

Why is this a conspiracy theory? It's trying to understand what the facts were, and what ought to have happened.

Since we don't have all the possible data available, is it not reasonable to figure out what data would be useful to get?

Will, you were the guy who was complaining about TUE abuse. Wouldn't you like to know how many of the 12 AAFs cleared on TUEs were Landis for cortisone? That would indicate the scope of the abuse, wouldn't it?

puzzled,

- TBV http://trustbut.blogspot.com for Landis news, research, and comment.
Will

Baltimore, MD

#10 Sep 16, 2006
Because, as you say, "we don't have all the possible data available", then you're dealing in a theory, and a very speculative one at that, given the lack of data from which to draw meaningful conclusions.

As for the CONSPIRACY part, that follows from your taking a chorus of "if"s and turning them into a conclusion that someone is "hiding" something:

"... That's why I'm wondering if Landis waiving confidentiality could result in determining if he was one of the TUE-ed riders. If he does that, and it is still not released, then I start to think that somebody is hiding something. But I'm a known transparency nut, so take that with a grain of salt."

I'm heeding your advice about the grain of salt.
TrustButVerify

Santa Rosa, CA

#11 Sep 16, 2006
OK, I'm occasionally guilty of pursuing every branch of a tree of conjecture to see where it goes. Ignoring every from "if he does that and it is still not released" as a branch that is uninteresting to you, and just consider what the data could explain (or not) if it WAS released.

Don't you want to know if 7 of the 13 TUE-ed AAFs were Landis? That would mean there were 6 other ones in the tour, which says something about TUE abuse, which has bothered you in the past.

TBV
LNDD

Valley Stream, NY

#12 Sep 16, 2006
So, taking TBV one step further we can get to the idea that had FL had returned an AAF for cortisone on an A, his TUE would have excused it. Had he not had an AAF for cortisone, and it is generally accepted he had been getting cort shots in his hip, as he publicly stated, then we should be able to conclude that the concentration was not so much that it would cause an AAF.

However, if the dose WAS enough and he still was not returning an AAF for it, then what gives? Does the test not work?

Further, if the current test (st. 17 results of IRMS) in question identifies the cortisone metabolite, which the avaiable study info indicates it does, but does not show an exogenous source (determined by the C13/C12 ratios or subsequent "differentials) then there is a big problem.

Simply put, should the IRMS not indicate exogenous cortisone metabolite in FL urine from st17, then the test is a sham or its not his urine.

Key to this is understanding the total amount and frequency of the cortisone shot FL was getting and any subsequent cort related AAF's that can be attributed to FL.

TBV sounds like he is on to something....TUE's/FL cortisone shots/IRMS results...
TrustButVerify

Santa Rosa, CA

#13 Sep 16, 2006
LNDD wrote:
Key to this is understanding the total amount and frequency of the cortisone shot FL was getting and any subsequent cort related AAF's that can be attributed to FL.
Well, yeah, except we don't have ANY of that data. Landis hasn't said diddle about when exactly he got shots, or how big they were. NOR do we have any useful info about the other AAFs, and whether any were his.

I don't know what leverage there is to get any other AAF/TUE results for him out of the parties that hold the data.

I'll assume that Landis could make the shot info available, and that he probably should. I'm still pissed that he hasn't released the filing and the lab reports, so his credibility isn't as high as it could be for me.

He could also release info about exactly what samples were taken at what times, but hasn't.

TBV http://trustbut.blogspot.com for Landis news, research and comment.
Slovenian Princess

Fruita, CO

#14 Sep 16, 2006
TrustButVerify wrote:
What I've heard is that none of these tests are supposed to be affected by dehydration (they can correct for it); and that shouldn't have been an issue on S17 because he was plenty hydrated.
The 'masking' theory might be that he was dehydrated after S16, and that was factored incorrectly into that nights administration of E masking agent.
this is what i am going on about, can you tell me where you heard this about the dehydration? as posted, i see it differently, if they are making adjusments for dehydration factors, then they know that it can skew the results...along with the info that a 24 hour period (of sampling) is needed to achieve credible results in the testing of urine, the dehydration during S16, to my sensibilities, is important.
pareader

Lititz, PA

#15 Sep 16, 2006
Several thoughts to the comments listed above. Landis stated that he had 8 tests and 3 of them were blood. However, I have heard conflicting numbers from 6 - 8 tests. Most persons have said that he was tested twice after the stage 17 test. I have also read that he was tested 4 times before stage 17 and 3 times after, which would mean that he was tested every stage afterwards. We definitely know that he was tested on stage 19 and 20 since he was in the yellow jersey.
TrustButVerify you stated that we do not know whether the CIR test was done on the A sample. You also make this note on your website. However, it seems to be very likely that the CIR was done on the A sample. Why? Because if you remember the NY Times reported that his testerone included exogenous testerone, citing info from a source in the know. This info was reported before the B sample was tested. The only way this would be known was if the CIR test was done.
Will

Baltimore, MD

#16 Sep 16, 2006
Slovenian Princess wrote:
<quoted text>
this is what i am going on about, can you tell me where you heard this about the dehydration? as posted, i see it differently, if they are making adjusments for dehydration factors, then they know that it can skew the results...along with the info that a 24 hour period (of sampling) is needed to achieve credible results in the testing of urine, the dehydration during S16, to my sensibilities, is important.
Princess, I think it's helpful to look at the PURPOSE FOR A TEST -- is the purpose for the test MEDICAL DIAGNOSIS, as for some pathological condition, or is the purpose for the test SCREENING, as for those "unusual datapoints" or something out-of-the-ordinary that might signal doping? If the test's purpose is medical diagnosis, then 24-hour urine collection is optimum; but if the test's purpose is to screen for the "unusual", then a sub-optimum one-time only sample can work to trigger the testers to TAKE A CLOSER LOOK at the particular sample, as through more intensive CIR testing, and/or to TARGET THE SUSPICIOUS TESTEE for heightened scrutiny of other tests, past and future.
pareader

Lititz, PA

#17 Sep 16, 2006
Also, TrustButVerify you say that Landis has not said diddly about when he received his cortisone shots. I know that I read he received a shot before the Tour and then once during the Tour. I looked for it and I think I might have read it in the interview Bicycling magazine did. I no longer have the copy in my possession. He noted that his hip was not feeling too badly at the moment of the interview. He stated that a cortisone shot works for about a month and he was still within that month window. I wish I could find the info so I could be more exact.
pareader

Lititz, PA

#18 Sep 16, 2006
I did some looking back at the Tour. Landis was in the yellow jersey and therefore tested after Stage 11, 12, 15, 19, and 20. He won stage 17 and was tested. I also believe every rider goes through blood work ups prior to the Tour. If that is true then we would know that he was definitely tested 7 times. He may have been tested as a random test on another occasion.
Will

Baltimore, MD

#19 Sep 16, 2006
Slovenian Princess wrote:
<quoted text>
this is what i am going on about, can you tell me where you heard this about the dehydration? as posted, i see it differently, if they are making adjusments for dehydration factors, then they know that it can skew the results...along with the info that a 24 hour period (of sampling) is needed to achieve credible results in the testing of urine, the dehydration during S16, to my sensibilities, is important.
Princess, I'm not sure that dehydration should be focussed on so particularly here. ALL urinalyses CORRECT for "dehydration", in the sense that urine is a body fluid whose total output and whose concentration of dissolved particles varies greatly even within the same individual over time. One's urine output, even a 24-hour output, varies and depends on hydration (how much fluid has been taken in over a particular period of time) but also includes factors such as how much fluid is lost in sweating; the concentration of urine depends alot on non-fluid things, like how much glucose and protein molecules are dissolved in it, so that ALL tested urine has to be CORRECTED with reference to some standard concentration which, in the case of specific gravity, is water. Contrast this with blood, which is a body fluid in a relatively CLOSED system with a relatively constant volume.

The point that I'm getting at is that dehydration is always compensated for in every urinalysis. Since the purpose of urine testing is to SCREEN for abnormal signs that would TRIGGER more sensitive CONFIRMING testing for doping such as a CIR test, then a non-optimum one-time sample is adequate and "credible" to accomplish this screening purpose. Make sense?
Will

Baltimore, MD

#20 Sep 16, 2006
pareader wrote:
I did some looking back at the Tour. Landis was in the yellow jersey and therefore tested after Stage 11, 12, 15, 19, and 20. He won stage 17 and was tested. I also believe every rider goes through blood work ups prior to the Tour. If that is true then we would know that he was definitely tested 7 times. He may have been tested as a random test on another occasion.
Thanks for your contribution, pareader; along similar lines, I posted this on Aug 20th in another thread:

Will Dundalk, MD Reply
|Flag for Review Sunday Aug 20

Here is a quote from a Landis interview article in VeloNews.com , dated 7/10/06:'..."Whatever happens, I am focusing on the race itself," Landis said."Racing is therapy for my hip. It consumes everything I think about. While I am racing, I have the least problems."

So far, he's refused to take pain medication, said Phonak team doctor Denise Demir, who also confirmed Landis received two cortisone injections into the joint area this year to help reduce the pain and inflammation....'

Here is another quote from a Landis interview article published 7/10/06 in the International Herald Tribune's online service:'...On my second day with Landis, we traveled with Kay to Chao's San Diego office for Landis's pretour cortisone shot in his hip.(Cortisone, a non-performance-enhancing hormone with a variety of anti-inflammatory and other beneficial effects, is a banned substance. Landis's condition, however, which his doctors have selectively described as "bursitis," has allowed his team to obtain a therapeutic use exemption from the Union Cycliste Internationale, cycling's governing body.)....'

DEPENDING ON WHETHER THERE IS ANY OVERLAP IN THE ACCOUNTS, LANDIS HAD 2 OR POSSIBLY 3 CORTISONE INJECTIONS TO THE HIP, WITH AT LEAST 1 OF THE INJECTIONS DECRIBED AS HIS "PRETOUR CORTISONE SHOT".

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