A history on blood transfusions in cycling, part 2

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Francesco Moser in pink(Image credit: Bettini Photo)

The recent revelations by the Dutch newspaper De Volksrant concerning the PDM team's doping regime at the 1988 Tour de France raise more questions than they answer, particularly with regard to the use of blood transfusions in 1980s cycling. Here we consider what is known about the use of transfusions in general and some of the questions these latest PDM revelations raise in relation to the history of blood doping in cycling.

After the 1977 confession from Joop Zoetemelk transfusions don't appear again in the known history of cycling until 1984 when, in January of that year, Francesco Moser beat Eddy Merckx's 1972 Hour Record, twice in the space of five days. Everything about Moser's Hour screamed proper preparation, a real scientific assault on the record. Like Merckx's record a dozen years earlier it was set at altitude, but in most other regards Moser and Merckx were playing by different rules. Moser made his assault on the record in January, after months of preparation whereas Merckx – and other Hour men generally – rode at the end of a long season on the road. Moser's bike was state of the art and – somewhat counter-intuitively – heavier than the machine Merckx rode on.

Today, most all the credit for the 1,720 metres Moser added to Merckx's record over the two rides is given to the scientists who worked with him: Francesco Conconi of the University of Ferrara's Centre for Biomechanical Studies, and his assistants, principally his protégé Michele Ferrari and the man who would go to be the Good Witch of the North to Ferrari's Wicked Witch of the West, Aldo Sassi. Conconi's principle contribution – his area of speciality – was in identifying Moser's lactate threshold, the limit of exertion the aging Italian star could ride at without producing more lactic acid than his muscles could deal with.

This Conconi was able to boost by the use of blood doping, a fact Moser finally confirmed in 1999, after the Festina affaire caused the skeletons in cycling's cupboard to be rattled. "I was not the only one nor the first who used blood transfusions to improve my performance. I was told that Jacques Anquetil had done it and that was well before my time. […] It was my own blood. And I was not the only rider doing it," Moser told L'Equipe. (For the record, one journalist – Joël Godaert – claims that Merckx was offered a transfusion for his 1972 assault on the Hour but declined.)

Quite when Conconi began working with blood transfusions is not clear. What is known is that in the early 1980s the Italian athletics federation, with the support of the Italian Olympic committee (CONI) had put Conconi in overall charge of the preparation of their athletes ahead of the Los Angeles Games in 1984. And that doping – with both drugs and blood – was part of Conconi's armory. This fact is known because another Italian coach, Sandro Donati, publicly complained about the practices employed by Conconi and his staff at the Ferrara institute, particularly the use of blood doping,

Donati was appointed coach of Italy's 800 and 1,500 metre male runners in 1981 and shortly after his appointment was introduced to Conconi. When Conconi explained some of his procedures to Donati, particularly the manner in which he had refined the Finnish experience with blood transfusions, Donati took this as proof that some of Italy's successes at the Moscow Games in 1980 had been achieved with the aid of blood doping.

A man of principle and something of a puritan when it comes to doping, Donati was not interested in such procedures. When he and his athletes refused to work with Conconi, Donati was informed that his position as national coach would be terminated after the 1984 Games. Conconi remained in situ and transfusions remained part of the Italians' armory in preparing for Los Angeles. Donati, though, was not a man for taking defeat lying down and, finding his complaints ignored by CONI – who had the dual mandate of both policing and promoting Italy's Olympic efforts – took his case to parliament. There he met with a politician who was also a haematologist, Andrea Ceci.

In 1985 a question was tabled in the Italian parliament, asking the health minister to state whether or not blood transfusions were against the rules. Again, you have to remember, that the procedure was not yet specifically banned in sport. In fact, the IOC had been petitioned to ban transfusions after the 1976 Games but their medical commission – led by redoubtable Prince Alexander de Mérode – refused, on the basis that it was impossible to test for transfusions. When faced with a parliamentary question from Ceci, the Italian health minister didn't care whether transfusions could be tested for or not. They were declared illegal under Italian law.

Cycling in the US in the early 1980s was a minority interest sport. But it was getting more and more lucrative. Jim Ochowicz and George Taylor had been able to secure the support of the 7-Eleven chain of convenience stores to sponsor a team of cyclists led by the former champion speed skater, Eric Heiden. 7-Eleven were already funding the construction of the vélodrome for the Los Angeles Games, and Taylor and Ochowicz had sold them on the idea of sponsoring their team by saying 7-Eleven could effectively own cycling in the US. By the time the 1984 Games came around 7-Eleven riders – male and female, track and road – filled nine of the twenty-three seats in the cycling squad.

The American cyclists had a great Games. A medal drought dating back to 1912 was ended in spectacular fashion, with the cycling squad bringing home nine medals, four of them gold. Blood doping wasn't the sole cause – the Americans were helped by the absence of the Soviet riders and by the presence of some pretty good riders – but blood transfusions did play a role in some of the successes: five of the squad's medallists, along with three others, confessed to having used transfusions. When this was made public, months after the Games ended, all the medals won were tainted by the stain of blood.

The US blood doping programme began life in 1983 when Ed Burke, who held a PhD in physiology and was technical director to the cycling squad, first floated the idea of the US cyclists making use of transfusions. The US Olympic committee, USOC, told Burke he could go ahead but only if the cycling federation were willing to give the project the green light. So Burke took his proposal to the USCF, who stalled on the subject, saying neither yay nor nay. Burke's plan went into the bottom drawer.

Ahead of the Games one rider who was seeking to gain selection, Danny van Haute, underwent a transfusion under his own initiative (there had been talk among the squad of Burke's shelved plan). Van Haute here had the advantage of having a father who was a medical doctor. His performance in the trials won him selection. And served to encourage other riders to want to make use of transfusions at the Games themselves. At which stage the coaching team intervened. Not to discourage the use of transfusions. But – they claimed – to make sure they were done properly and safely.

Not all the riders underwent the procedure. One who refused was Connie Carpenter – the mother of Taylor Phinney – who opened the Games with gold in the women's road race. As far as she was concerned, it was the coaching staff who were responsible for allowing transfusions to become part of the squad's preparation: "It's real bad for cycling, and it's real bad for all of us who didn't participate: The blame falls directly on the coaching staff, and from everything I've heard since, I'm surprised nobody died," she told Sports Illustrated.

The key coaching staff involved here were Burke, federation vice president Mike Fraysse and coach Eddie Borysewicz. There being insufficient time to extract blood for reinfusion they decided to use blood from compatible donors among the riders' friends and families (heterologous transfusions). Nor was there time to spin out the red blood cells, so the transfusions were of whole blood. A cardiologist from the University of Iowa – Herman Falsetti – was brought in to carry out the transfusions, which were performed in the comfort and safety of a Ramada Inn.

There are several different versions of how the US cycling squad's blood doping came to the attention of USOC and USCF after the Games had ended. Who said what to whom and why is unimportant here. What matters is that in January 1985 Rolling Stone got hold of the story. In an effort to spike Rolling Stone's guns and control the news cycle other media outlets – press, magazines and TV – were fed versions of the story. But no amount of spinning was going to deflect this story and – regardless of the fact that transfusions were not banned – the sheen was very quickly and very publicly taken off the cycling squad's successes.

Interviewed by Daniel Friebe for his Eddy Merckx biography, The Cannibal, Roger de Vlaeminck made reference to the use of blood transfusions when he was a member of Moser's 1984 Gis-Tuc Lu squad. "They spoke to me about blood transfusions." De Vlaeminck told Friebe. "When I was riding for Francesco Moser, they asked whether I wanted to give half a litre of blood to put in the fridge. I said no…"

That the Gis squad may have made use of blood transfusions in 1984 is hardly a surprise. We know that Moser had used transfusions to set the Hour record in January, he did eventually confess to this fact, in 1999. Whether the Italian used the procedure at other times, especially in the Indian Summer of his career in 1984 when he won Milan-Sanremo and the Giro d'Italia, remains unknown. Part of the reason suspicion surrounds these victories is that it seems crazy to imagine that transfusions, their effectiveness having been proven, wouldn't have been used again and again and again. Another part of the reason is that, in 1984, Michele Ferrari started working with Moser's Gis team.

Ferrari was on the staff at the University of Ferrara and part of the team Francesco Conconi had assembled to prepare Moser for the Hour. In 1984 Ferrari was moonlighting with Moser's squad, splitting his time between Ferrara and Gis. For the 1985 season he went full time with the team. In 1986 Moser switched squads and joined Gianluigi Stanga's Supermacati outfit and Ferrari went with him. Ferrari stayed with Stanga through to 1989, by which time the team had become Château d'Ax. It was there that he first hooked up with Toni Rominger, who hired him as his personal coach after Ferrari had quit Château d'Ax and hooked up with Moreno Argentin.

Working with Argentin, Ferrari became a part of Giancarlo Ferretti's Ariostea squad, briefly working alongside Luigi Cecchini. That, as we all know, lasted through to 1994, by which time the team had become Gewiss, and Ferrari made his infamous orange juice comment. After that, Ferrari went into private practice, hanging a shingle on his porch and waiting for rider's to come to him. Rominger setting a new Hour record toward the end of the 1994 season acted as an advertisement for Ferrari's abilities, especially with Rominger doing a Moser, first beating the record by 792 metres and then coming back two weeks later to stuff another 1,459 metres onto the distance.

Apart from that one reference by De Vlaeminck to the use of blood transfusions at Gis in 1984, there is no evidence that transfusions continued to be used at the team beyond that one season. There is no proof that transfusions were used at Supermacati, or at Château d'Ax, or at Ariostea. We can say, with some degree of confidence, that Ferrari is suspected of having advanced to EPO by the time the 1994 Gewiss squad started to strut their stuff. But we don't know anything about the use of transfusions. Not in the teams Ferrari worked with between 1984 and 1994, nor in any other teams in the professional peloton. In fact, up until the recent PDM revelations, there is no evidence at all of transfusions having been used in cycling after 1984, not until their reappearance a decade and a half later.

So what happened after 1984 to make blood transfusions fade away? First up, there was the IOC finally moving to ban the procedure. In 1985 those who had tried to get the IOC to ban the use of transfusions after 1976 renewed their efforts and, with the scandal in the US raging, Sandro Donati kicking up a rumpus in Italy and a number of other athletes having confessed to having used the procedure, the IOC was backed into a corner. Transfusions were added to the banned list from 1986 onwards.

That, of course, is insufficient reason for blood transfusions to disappear. From the case of the US Nordic skier Kerry Lynch – who was busted for blood doping after someone spilled the beans on what he and a couple of US coaches were up to – we know that transfusions were still being used in the wider world of sport as late as 1987. And, from the revelations in the Dutch daily De Volksrant, we now have evidence that they were part of the armory in the PDM squad in 1988 (these claims we'll consider in greater detail in the final part of this series).

By the end of the 1980s, transfusions are thought to have fallen out of favour. There was talking of developing a test to detect them – Bo Berglund published a paper, Detection of autologous blood transfusions in cross-country skiers, in which he proposed a form of indirect detection based on the difference between two samples taken a week apart – but that isn't what is supposed to have drawn the curtain closed on the use of blood transfusions. No, they're supposed to have fallen out of favour because they were superceded by the new thing: EPO.

Quite when this happened is not clear, different people will give you different dates anywhere between 1987 and 1992. It is clear that, at the Winter Olympics in Calgary in 1988 the existence of EPO was already being discussed openly. It is clear that as early as 1988 scientific papers were being published trumpeting the beneficial effects of EPO in the sporting community. It is clear that as early as 1988 the international Ski federation banned its use (the IOC waited until 1990, the UCI 1991). And what is also clear is that as early as 1988 bodies were beginning to pile up on mortuary slabs as athletes in several sports began to experiment with EPO and die in their sleep. Gen-EPO was taking its first, faltering steps.

On a simple cost/benefit comparison EPO trounced transfusions, made them redundant. Though expensive in the early years EPO's price quickly fell. But even above the cost, EPO was logistically less complicated than transfusions, vials of EPO could be transported in ice-packed thermos flasks. There was simply no reason to engage in the hassle of expensive transfusions. Until, that is, tests for EPO came along in 2000/2001. At which stage transfusions – which were still undetectable – once more became part of the doping armory. Evidence, though, suggests that transfusions did not go away. Evidence suggests that transfusions remained part of the armory, at least for some,