A history on blood transfusions in cycling, part 3

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Steven Rooks in the polka dot jersey at the 1988 Tour de France. Next to Rooks is Dutch PDM teammate Gert-Jan Theunisse and yellow jersey Pedro Delgado.(Image credit: AFP)

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.

The possible sporting benefits of blood transfusions have been public knowledge since the 1940s. Through the 1950s little seems to have occurred on this front but by the 1960s more and more people were interested in ways to manipulate athletes' blood. As we saw in the first part of this series, the 1970s are thought to have seen transfusions come to the fore, though few names have been definitively linked to the procedure. In the second part we considered the 1980s, particularly the watershed year of 1984, and the IOC's banning of transfusions, which up to then had been wholly legal. Conventional wisdom has it that, shortly thereafter, transfusions fell out of favour in the sporting world, having been superseded by the use of EPO and didn't come back into vogue until the early years of the new millennium. Recent revelations, though, suggest they came back into vogue a lot earlier than people thought.

Before considering how little we know about the use of blood transfusions in 1990s cycling, let's return to the 1980s and consider how little we really know about their use in that decade. Most all the early evidence we have for the use of blood transfusions in cycling dates to 1984: Francisco Moser's Hour record, the US Olympic cycling team and, most recently, the suggestion by Roger de Vlaeminck that transfusions were in use at Moser's Gis squad. Beyond that, you will be hard pressed to find evidence of the use of transfusions in cycling in those years. Until, that is, the recent revelations about the 1988 PDM Tour de France squad.

The Dutch daily De Volksrant's revelations about doping at PDM in 1988 are just the latest in a long line of stories about what happened at that team. That PDM doped is like the Pope's religion, something everybody knows. The team's name – Philips Dupont Magnetics – has been recast in multiple languages. In Dutch it's become Prestaties Door Manipulaties (performances through manipulation). In French it's Plein de Manipulation (full of manipulation). Pills, Drugs and Medicine is how the English-speakers say it.

For some it may seem odd that none of the previous PDM inquiries have uncovered the use by the team of blood transfusions. Or that none of the PDM riders who have confessed to doping during their time in the peloton have mentioned the use of transfusions. That previous investigations made no mention of transfusions may simply be down to their scope. Those investigations come from the 1990s. The main PDM investigation was actually into tax evasion by a pharmacist who was supplying drugs to the team. Transfusions may simply not have arisen as a topic of inquiry.

That former PDM riders haven't mentioned their use of transfusions is harder to explain, other than to say that few riders ever seem to confess everything. Gert-Jan Theunisse, for instance, has confessed to having used other drugs during his career but denies ever having used testosterone, despite having failed several tests for the substance. The lack of other evidence to support the use of transfusions by PDM may mean that the team only briefly dabbled with the procedure. Or it may be that De Volksrant's revelations about the use of transfusions should be taken with a pinch of salt, or at least held in reserve until more pieces of the jigsaw appear. Quite frankly, right now we don't know.

So what do we know about PDM's use of blood transfusions in the 1988 Tour? Based on what was revealed by De Volksrant we know that PDM are said to have acquired the knowledge of transfusions from Italy. As for their use, all we have is an entry in team doctor Bertus Fok's diary for 11 July 1988, at the end of the stage from Nancy to Strasbourg, showing that Steven Rooks, Gert-Jan Theunisse and Jörg Müller all received blood, on top of the other products Fok was administering (which included testosterone and cortisone).

The Nancy-Strasbourg stage had been the 1988 Tour's first day in the hills, the peloton passing through the Vosges. That was followed by a sprinters' stage down to Besançon, with the race entering the Alps on 13 July and tackling Alpe d'Huez the next day. It was on the Alpe that the PDM riders shone, Rooks and Theunisse claiming a Dutch one-two, with their former teammate Pedro Delgado coming home third and claiming the maillot jaune. After that came the race's second individual time trial, where Delgado solidified his lead in the race. And tested positive for probenecid. It's also where Theunisse popped a positive for testosterone.

The seventy-fifth Tour has gone down in cycling history not so much for the victory of Pedro Delgado as for the doping scandal that enveloped him in the last week of the race. Probenecid was banned by the IOC but wasn't due to be added to the UCI's banned list until a few weeks after the Tour ended. After first having denied taking any medicine, and after suggesting a spiked bottle must have been passed up to him on the road, Delgado did admit to having used probenecid, as prescribed by his doctor, François Bellocq: "Between Dr Bellocq and me," Delgado said at the time, "it's a question of trust. I have a problem with acid in my urine and we've been watching it for a long time."

It was Bellocq who Delgado nominated to attend the testing of the B-sample on his behalf. But Bellocq, for some reason, sought to distance himself from Delgado, writing to l'Équipe that he hadn't treated the Spaniard. This was somewhat unusual. Bellocq was a doctor with a reputation and it's usually the dopers who try to publicly distance themselves from such doctors. This time, the doctor was distancing himself from the doper. And Bellocq wasn't the only one putting distance between himself and Delgado. Eufemiano Fuentes also denied having treated Delgado.

Fuentes had started the cycling part of his career in 1985 with the Orbea squad, staying with them through to 1988, by which time they had become Caja Rural. One of Orbea's riders in 1985 was Pedro Delgado. In 1986 and 1987 Delgado rode for PDM, before returning to Reynolds in 1988, the team he had started his professional career with in 1982. Even though there was just that single season connecting them at Orbea, Fuentes was still linked by some in the Spanish media to Delgado. A link which Fuentes at the time denied. But which some claim Delgado confirmed, years later.

Fuentes had, even then, already established a reputation for doping. He himself had been an athlete in the 1970s, a 400 metre hurdler, right at the time that blood transfusions were being talked about openly in track and field circles. Fuentes' involvement with the Spanish athletics squad at the Los Angeles Olympics is thought to have involved him doping his charges with steroids. Some say he was utilising transfusions by the time the Seoul Games came around, and most seem clear that blood doping was definitely part of his game plan in the Barcelona Games of 1992, but whether that was EPO or transfusions is unclear.

The point about bringing Fuentes into the story here is not to suggest a link to blood transfusions in 1988, that Delgado's probenecid bust was an early echo positive – that would be too much dot joining – but rather to show how the backroom stars of Gen-EPO were already on the stage even before the drug arrived. Don't forget that, as well as Fuentes at Caja Rural, you also have to take into account the presence of Michele Ferrari at the Château d'Ax team that year.

Fuentes is most famously linked to transfusions through Operación Puerto, with most of the evidence there coming from the early years of the new millennium, when transfusions are understood to have come back into fashion. But can we link Fuentes to blood transfusions before they are thought to have fallen out of favour? There is an infamous story concerning Fuentes and the 1991 Vuelta a España, which may or may not concern transfusions. Flying into Mallorca in the Canary Islands, scene of the race's stage eight individual time trial, Fuentes is said to have had a cooler bag (or box) on the seat beside him on the plane (or on his lap – the details vary from telling to telling). The cooler's contents, Fuentes told journalists, held the key to the Vuelta. A Vuelta which was won by the man who won that individual time trial Fuentes flew in for: Melchor Mauri from Manolo Sáiz's ONCE team. The team Fuentes had been working with since the previous season.

What was in that cooler is not clear. We know that both EPO and blood bags would require the use of a cooler for transportation, and in 1991 either could have been in use. We know that EPO was coming into use at that stage, its influence spreading throughout the professional peloton. But we do not when different teams started using it. Even if EPO was in use at ONCE in 1991, why it would be necessary to fly it in during a race is not clear. The drug wasn't illegal in Spain and the UCI were only about to add it to the banned list. There is no reason why the team cars couldn't have been fully stocked at the start of the race. Flying in fresh blood bags, on the other hand, does make sense. But that doesn't mean it was blood in that cooler Fuentes was carrying. As well as blood and EPO, you might want to use a cooler to keep sandwiches fresh and that may have been all Fuentes was transporting. Maybe Mauri really did win that race on pan y agua. We do not know.

Skip forward a decade. Gen-EPO has blossomed and bloomed but now a test for the drug is available and its use has been restricted, somewhat. Transfusions, which at this stage are supposed to have been a thing of the past, re-enter the picture. Pretty much from the moment the EPO tests arrived – at the Sydney Olympics in 2000 and ahead of the 2001 Classics season – transfusions were being whispered about. The first major evidence of their use came in 2004 when Jesus Manzano spilled the beans to AS about what had been going on at the Kelme team. Fuentes was suddenly the star of a new era of doping. But he is not the one who got the show on the road.

From the recent USADA report we know that the USPS squad, with Michele Ferrari acting as their training consultant, had used transfusions during the 2000 Tour. From the Ferrara investigation into Francesco Conconi and his colleagues we know that, during searches, a bag of blood was recovered in 1999. From the Freiburg report, we know that as early as 1998 Telekom's doctor, Lothar Henrich, had begun experimenting with transfusions.

In 1997 the haematocrit test was introduced. It is not inconceivable that, as soon as that arrived, some began turning to transfusions as a means of fighting the restrictions the H-test was imposing upon them and didn't need to wait for an actual EPO test to spur them on. The evidence from the USADA report, the Ferrara investigation, the Freiburg report, it requires just a minor adjustment to the received wisdom about the use of transfusions, it can be made to fit the accepted picture, the picture which shows that transfusions fell out of favour and only returned as EPO use was restricted. But how do we explain the use of transfusions as early as 1996?

"Bjarne told me how, in his 1996 Tour de France victory, he'd done three transfusions: one just before the Tour started, and one on each of the two rest days. He explained the reasons they worked so well; how, unlike the slow rise in haematocrit created by EPO, transfusions provided an instant boost of around three points, which correlated to a three percent increase in power. They were like a fountain of youth."

While Riis was part of the Telekom team at this point and they had Jeff d'Hont as soigneur and Lothar Henrich as team doctor, the Dane seems to have managed his own preparation. Riis was using the services of Luigi Cecchini as his personal coach, the two having first met at Ariostea in 1992. Riis has always denied that Cecchini was hands-on with regard to the actual doping, so who assisted Riis's transfusions is not known.

Both Riis and Cecchini have been linked to Fuentes but, in 1996, those links appear to have been in the future. Cecchini claims not to have met Fuentes before 2001. Riis, of course, denies any link to Fuentes. Where Fuentes was working in 1996 is not clear. After finishing with ONCE in 1991 he worked with Amaya, who folded in 1993. He's then not heard of in cycling until he joined Kelme, which is understood to have been 1998. The dots may all be there, but there is no reason to join them and link Fuentes to Riis's use of transfusions in 1996. You need to find another fall-guy for that.

So what have we got here? We have evidence pushing back the point from which transfusions were thought to have disappeared from cycling, going beyond 1984 and suggesting they were in use as late as 1988. We have evidence pulling forward the point at which transfusions reappeared in cycling, suggesting they were is use as early as 1996. What we don't have is any evidence from any riders that this new evidence can be believed. As has been acknowledged, no PDM rider has thought to mention the use of transfusions up to now, even though several have confessed to doping. Bjarne Riis didn't think to mention transfusions, either in his 2007 confession or in his autobiography, "Stages of Light and Dark". If cycling's history over the last four decades is blood steeped, so far it's been well hidden behind the curtain of silence.

Why does the role played by transfusions in the years before Gen-EPO matter? Why does the role played by transfusions during Gen-EPO matter? It matters because it alters our perception of what happened in those years. Many cycling fans have a somewhat rose-tinted view of doping in the years before Gen-EPO, comparing the two eras to pop-guns versus howitzers. Doping is an arms race, and in an arms race you move from pop-guns to howitzers and on past intercontinental ballistic missiles. If blood transfusions were part of the armoury the pop-guns versus howitzers view needs to be reconsidered. You can compare EPO to howitzers if you want, but you cannot say that transfusions were just pop-guns.

The path from transfusions to EPO is clear and unambiguous. In one you inject red blood cells into the body, in the other you inject a hormone that stimulates the production of red blood cells. For the men who worked with transfusions in the 1970s and 1980s, the progression to EPO was as natural as upgrading your smart phone. One might be more powerful than the other, or at least easier to use, but the two are, in essence, the same thing. But there is another link between EPO and the doping that was going on before Gen-EPO came along.

Let's reintroduce François Bellocq into this story, the man who denied having been Pedro Delgado's doctor in 1988. Bellocq was an early champion of what is know as hormone rebalancing, topping up depleted cortisone and testosterone levels. In 1991 Bellocq published a book, "Sport et Dopage - Le Grande Hypocrisie", which explained his thinking: "I believe that the limits of sports medicine amount to stopping an athlete from digging into his body's resources, and replenishing a body from which professional sport demands so much."

Replenishing, though, is where the problems arise. Over the course of a stage race, a rider's testosterone levels will naturally fall. As will their levels of other hormones, such as cortisone (EPO, it should be pointed out, is also a hormone, one which regulates the production of red blood cells, which like testosterone get depleted over the course of a stage race). Bellocq simply advocated rebalancing those levels. Whatever the body naturally used and couldn't replace quick enough, well it was permissible to top that up to its natural levels.

The problems with the hormonal rebalancing argument begin when you start to question how you draw the line between topping up to a natural level and over-filling the tank. What, in other words, is the difference between hormone rebalancing and doping? Richard Moore, in his "In Search of Robert Millar", notes Bellocq's answer to that question, taken from "Sport et Dopage": the difference is the same as "the difference between the love of a good wine and alcoholism." Except that, stretching Bellocq's analogy, this was the age of Prohibition and the doctors were running speak-easies.

Among the riders who beat a path to Bellocq's door – a long list of the great and the good of the sport – was Bernard Hinault. Philippe Brunel interviewed le blaireau for l'Équipe in 1999 and, after questioning Hinault on the topic of hormone rebalancing, moved on to blood doping. Here's what Hinault had to say to Brunel: "Moser made use of auto-transfusion. So he was playing with his own blood. He did no more no less that the Finnish athletes, Lasse Virén and the others. It suffices to take some of one's own blood during the Spring when it is rich, hyper-oxygenated, and to re-inject it when one is fatigued. Is that really doping? Maybe not, except if the blood is placed into a machine to re-oxygenate it to the maximum."

Hormone rebalancing, blood transfusions, EPO, they really aren't all that different. The members of Gen-EPO, were they really all that different from the generations that went before them? Scapegoating them for doing the same as the generations that had preceded them had done, does that really make sense? But they're the ones who are going to be held accountable. They're the ones who we are clamouring for truth from. While we sit back and watch the generations who preceded ride off into the sunset in glorious silence, never to be held to account for the role they played in creating Gen-EPO. Because they were only playing with pop-guns.