Saturday, September 30, 2006

What TUE covers morphine?

In e-mail yesterday, a ferret sent some images that appear to be of lab documentation, along with a taunt to see if I could figure out what they meant. There are three scans, the first of which is a nearly illegible full page. The second two are better blowups of parts of the page. You can click on them to get them full size. [more]

[includes corrections by readers]
What do we have? The top left of image 1 appears to indicate that this is a document from LNDD in the sport Cyclisme, dated 20-July-2006, and if you look close, it says TDF ... Morzine.


The second image is a table that appears to hold the results of some tests for three samples, numbered 994178, 994179, and 995474. The testing protocol is for the stage winner, the yellow jersey and a random to have been sampled. That would be Landis, Peirero, and someone else. My transcription of image 2 is:

No
994178
994179
995474
Sexe
M
M
M
Filtrat(F)



volume
95
85
65
ph-bande
5
7
5
d-refract
1.030 1.018 1.026
ES06-m
x
x
x
ES02-Eph
X
X
X
ES02-bba
x? 2709
x
x
ES04-H
x
x
x circled
Tg/Etg
0.1
10 or 1.0?
4.9
ES050-MS2
x circled
x circled
x circled
ES02B-LCH
x
x
x
ES08B-PS
x circled
x
x circled
ES08-HES
x

x
ES107-Epo
x
x
x

Things that seem interesting about this table: Why are some entries circled, and some not? What is the "2709" and heavy writing in the '178/bba cell about?

The three values that appear to be T/E are odd. One is 0.1, with is 1:10 an odd way; one is either 1.0 or 10.0, it's hard to tell it there's a decimal place there. In other places, there is a very clear euro-style "," used as the decimal point, but here it is either missing making it a 10 or runs into the 'x' of the cell below. The last T/E is reported as 4.9. Are these the T/E values of the current test, or previous reported values? If they are previous, how are they matched to riders if it is supposed to be confidential at this point?

Why is there no HES value for the '179 sample?

The third image appears to be a set of findings from the bottom of the first image, and seems to say the following.
995474 T/E (dc) = 11.4 28 circled.
presence de Prohibituer de derivahnon
994178 \
994179 / Triamcinolone Acetonide interference?
995474 - Cefeine (dc) en attente surveillance AMA.
996179 - Morphine less than seuil

B accouples 28/7/6 a 15h45 par: V8

+ circled
One thing this indicates is that I can't read French, or french handwriting, so anyone with better eyes, please mail or post corrections.

Second, that '474 appears to have been flagged on a T/E of 11.4. Let's assume this is Landis, so that means '178 and '179 are Peirero and some other rider.

Third, that '474 seems to be under surveillance for caffeine. This should probably be considered an official UCI/WADA endorsement of the efficacy of Peet's Coffee.

Fourth, that '178 and '179 were not tested for something because of interference of some kind, but there are no indications of a test in the table that were not done for them but were done for '474.

Fifth, '179 appears to have contained morphine, at a level less than seuil, a relatively high pH value of 7, and a low d-refracte of 1.018. Comments below say that seuil is a 'threshold' value, described in this WADA doc. Is morphine of any use to any cyclist? Was this reported as an AAF? Did anyone have a TUE for morphine? Is the lab contaminated with morphine somewhere? Is this a poppy seed bagel opiate reading? What is going on here?

Sixth, what are the (dc) markings -- are they attribution to lab director De Ceaurriz, whose initials are "DC"? Is this his handwriting? Why would he be involved in preparing these forms?

Finally, if the T/E in the tables are previous values, then Landis had a 4.9 in a previous test, and changed to an 11.4. Going from 4.9 to 11.4 is a little over a 2X change, which doesn't seem huge to me. Why wasn't the 4.9 reported as an AAF before, with the limit currently being 4.0? If the '179 previous value was 10.0, why wasn't it reported as an AAF? It these aren't previous values, how did 4.9 become 11.4 when copied from one section of the form to another by the enigmatic (dc)?

Mr. Ferret, that's all I can get out of it. Everyone else, please send corrections and alternate interpretations, and I'll update this post.

12 comments:

Wschart said...

In the second image, apparently a blow up of a section of the full page, the row below the Tg/ETg row, labeled ES05-MS2, has 3 x's (?) not circled. There are 2 different styles of x, a 2 stroke normal x and a single stroke, looped sort of x. I wonder what is the significance here? Two different people filling in this form? Or is there some different significance in France for each style? Also the row ES02-bb3 row has an apparent write-over in the first cell, and a faint notation (partially erased?) between the first and second cell. Looks like P27 (something). What is this.

Anonymous said...

The T-something a-something interference looks like Triamcinolone Acetonide. This is a corticosteroid often used in the treatment of asthma or as a topical medication for dermatitis.

Anonymous said...

In 3rd image, 2nd line, what i read is "presence de P inhibiteur de derivation". The 11.4 could refer to this P (an arrow?), not to T/E.

For 178 and 179, I read "Triamcinolone Acetonide inférence ... de confirmation ... (ce pas?) confirme"

Regarding caffeine, it just says "en attente surveillance WADA", which just means WADA is monitoring caffeine results, not that the rider is under surveillance (the lab shouldn't have that information. For this same reason, the Tg/Etg value can't refer to a previous test)

Finally, for morphine I read "< semi". The last character I would say is a pointer to the previous line, i.e. morphine, like caffeine, is in the WADA monitoring program, and the remark is there only for informative purposes.

By the way, I believe they test 5 riders per day, 3 of them random, so you can't be sure Pereiro is one of them.

Anonymous said...

I'm the last anonymous again. For morphine it's not "< semi" but "< seuil" (seuil is threshold in French). The WADA-approved thresholds in 2004 are specified in the document
http://www.wada-ama.org/rtecontent/document/perf_limits_2.pdf

Anonymous said...

@ previous anonymous:

1. How do you get "WADA" from "AMA"?
2. Why would that "Surveillance" be attrinuted to one sample?
3. For you quote: "(the lab shouldn't have that information. For this same reason, the Tg/Etg value can't refer to a previous test)" - appearantly they do have this info, and can attribute it to a sample/rider...why else is it there? Where could it have come from/attribute to?
4. You state: "In 3rd image, 2nd line, what i read is "presence de P inhibiteur de derivation". The 11.4 could refer to this P (an arrow?), not to T/E."
I read this as Prohibituer...the T/E is very clear.

What is also surprising is the total amount of times this was revisited...dates abound...25/7/6...28/07/06...24/07/06...
According to this document, there were only 3 riders tested on July 20, 2006.

Anonymous said...

Why would a lab with all that fancy equipment have to hand write the results, it seems to me they should be from a print out. But then what do I know.

dan said...

I don't get how on the same form, the T/E ratio for 995474 could go from 4.9 to 11.4. This seems very strange. A ratio of 4.9 is not too far above the current threshold value of 4:1, and wouldn't be a "slam-dunk" of a case. 11.4:1, on the other hand, looks more incriminating.

What I'd really like to see is the raw data for the T and E to see if, as was initially claimed, Landis' T value was normal and the E value was very, very low. And for that matter, whether the T/E is really 4.9:1, 11.4:1 or some other value.

And in the third image, granted it's unclear, but it looks to me like "P inhibiteur de derivation" which suggests that P (whatever that is) inhibits the derivation of the value, or has somehow affected the derivation of this value.

I'm surprised they have this data handwritten, and not in some word-processed or computer-generated printout.

Anonymous post #3 states "By the way, I believe they test 5 riders per day, 3 of them random, so you can't be sure Pereiro is one of them."

If that's the case, perhaps this 995474 is not Landis, either? Because Landis is the person whose name has been dragged through the mud, it's easy to believe that this number belongs to him, but what if it didn't? Whose would it be?

Interesting images, but it still leaves things clear as mud to me.

- Rant

wasafloydfan said...

I wonder if the multiple, discrepant t/e values result from the fact that when they have a positive they redo the test multiple times on the A sample to "confirm." If this is the case, the large fluctuations (5-11.5) seem consistent with measurement difficulties caused the very low E level we are told Landis had.

Also, I wonder how labs manage the reporting of the confirmatory tests. What do they report? The highest (11-1?), the first (4.9-1?), the lowest??? Some average? From a statistical standpoint, we cannot judge the results fairly if high or low tests are cherrypicked from three different tests.

This is also very important from a PR perspective. For example, if the 4.9 and 11.5 are from multiple tests from the same A sample, then leaking only the 11.5-1 ratio made a big PR difference. If the number reported had been 4.9, the press would have focused much more closely on the recent increase in the threshold. Also, various explanations, like Floyd's alcohol consumtion, would have seemed much more plausible. As it was, the reported ratio seemed difficult to explain.

Marc said...

Following this with some interest, since it's a nice puzzle. I can usually read French handwriting fairly confidently, though the state of the digitized image renders some things virtually impossible to make out.

I think the "results" were first written up on 7/24, then "verified" on 7/25.

In that first result, for 995474, the words read: "presence de l'inhibiteur de dérivation," which I take to mean that some substance which interferes with the measurement was detected (but those who know how the testing operates might give a different meaning to "derivation").

In the second result, for 994178 and 179, the text after the name of the compound (I think anonymous is right that it is Triamcinolone Acetonide) reads: "inférieure au seuil de confirmation"--that is, is below the threshold at which it can be confirmed. Then follow a few words squeezed in which I can't make head or tail of. It looks like there's a "re," then a word beginning with "p," then below them a word which begins "confirm. . ." Is the writer suggesting this should be retested?

In the third result, for 995474, while "en attente surveillance AMA" makes sense (apart from not knowing what AMA stands for), I have a hard time sseeing an "a" in that messy letter or combination of letters that precede "-ttente," even after you subtract the upstroke from "seuil" in the line below. (I'm not even sure the word ends -te, wince I can't see a missing cross-stroke on anay other "t" in this section of writing.) But I can't sugggest what other word this may be.

The final result definitely says "Morphine < seuil."

Let me make a guess about the "T/E (dc) = 11,4 [28]" in the first result. Below the results section, there is the line "B accouplés:" "Accouplés" would mean "joined," "coupled." If this refers to associating the test on the B samples to the previously done A samples (and is in the plural because the form assumes multiple samples are being reported), that association wass made on 7/28. The 11,4 might have been the result in the B sample, and the circled "28" might be to indicate that that value was from the test on 7/28. Those who know when these tests were performed may be able to say whether this guess is possible or not.

One further observation, then two probably insignificant questions.

I agree with wschart that 2 different persons (at least) filled out the form. In the lab report section, the writer of the "d-refract." line uses a very European form of numeral "1," whereas the writer of the Tg/Etg line uses the straight-line numeral "1." But the writer of the Tg/Etg line uses a very European "9," whose tail curls back under it, while the writer of the "volume" line uses a "9" with a vertical tail. Is this two hands or three. Similarly, some "x"s are two-stroke exes, while others are drawn in a single stroke, as if they were Greek lowercase alphas. I find nothing sinister in this. It makes sense that different people in the lab would do different tests, and each would enter their own results.

For what it's worth, the handwriting of the numbers in the Resultats section seems more like that of the Tg/Etg line than of the other lines.

My two questions: What's being reported in the final column of the lab report section. Also, Why is the printed date at the top of the form 6/18/2006, while the handwritten date--presumably when the samples were turned in for testing--is 7/21?

Yours in sport (as my bicycle builder used to sign his letters),

Marc

Anonymous said...

AMA is WADA in French. Caffeine is being monitored by WADA, so labs report any positive finding.

dan said...

Marc has an interesting comment which addresses something that's been bothering me about this form.

According to news reports, the B sample was tested on 8/3. But from what I take that third graphic to show, "B accouples" sounds like the B sample, and there's a date of 28/07/06 at 3:45 p.m.

So when was the B sample really tested? According to what we heard as this whole mess was unfolding, it was on 8/3, but this form says 7/28. Something's very fishy here.

- Rant

Simon Brooke said...

You write: 'is morphine of any use to any cyclist?'. Morphine a purified form of heroin which is one of the ingredients of Pot Belge. It is a very powerful pain-killer and euphoriant, and I would expect it to be quite good at improving performance at the limit of physical endurance.

I've only ever had it myself in the immediate aftermath of breaking my back, but I can tell you that morphine makes the experience of travelling down a bumpy mountain road in an ambulance while suffering from a broken back not merely a tolerable, but even a pleasant experience.

So yes, for a rider in a stage race, morphine probably is performance enhancing.