The man with the plan

An interview with Rasmus Damsgaard, January 7, 2008

At a time when the sport of cycling was teetering on the brink of imploding under the weight of doping controversy, one team had the foresight to take action, and one man had the vision to make it happen. Born from the 2006 Operación Puerto case, Team CSC's anti-doping program is now becoming the standard for ensuring athletes are racing clean. Cyclingnews' Sabine Sunderland* spoke with the author of the program, Danish anti-doping expert Rasmus Damsgaard.

It was just before the 2006 Tour de France that Operación Puerto erupted, and Team CSC's star rider, Ivan Basso, was named in the investigation on the dawn of the race in which he was a favourite to win. Team CSC manager Bjarne Riis was left with the difficult decision to remove Basso from the team's Tour roster and later from the team entirely.

Basso's case was still being tossed around in the courts when Team CSC announced its ambitious new plan to monitor its riders throughout the season for evidence of doping. Even though the case against Basso was shelved, Riis let Basso go and then focused on protecting the team's sponsorship and reputation by working to institute a radical new plan: a team-funded effort to test its own riders for evidence of doping.

Enter Dr. Rasmus Damsgaard

A team taking an active role in deterring doping, rather than waiting for a rider to get caught and create negative publicity for the sponsors and the sport, was not a new concept. Several French teams had instituted measures to combat doping after the 1998 Tour de France, and the French federation put in place a program (suivi médical longitudinal) which involved quarterly tests which went beyond the UCI's standards.

But with the state of the sport in 2006, the Team CSC program had to go further to convince critics that its riders were clean, and it did so at a huge cost to the team.

The logic of a team spending a large fraction of its budget on anti-doping screens was quite unusual, but after a year in which Basso was quickly snapped up by Discovery Channel, only to have the scandal flare up again and see Basso subsequently admit to his involvement in Puerto, and in which the Tour de France was plagued by multiple doping scandals, the importance of a program like Team CSC's increased. Now, the name Rasmus Damsgaard is at the forefront of cycling's anti-doping efforts.

A physician since 1994, Damsgaard actually began his anti-doping work as punishment for refusing to serve in the military. "After working a couple of years as a practitioner, I was called to perform my military duty. I refused and was punished by the authorities," Damsgaard explained. "I was sentenced to community service. As I could choose the type of work myself, I chose a job as assistant in a semi-governmental sport testing centre for the Danish elite athletes."

What began as penance quickly became a passion. "It turned out to be the best time of my (working) life!" The 41 year-old received encouragement to pursue a PhD studying growth and maturation in elite sports children. "The growth and development of children depends on hormones - the same hormones as body builders and some athletes choose to apply to boost performance," he described.

Damsgaard then took a part-time job as General Secretary for the Danish Anti-doping Agency under its Swedish chairman Professor Bengt Saltin. While working there, Damsgaard continued his research. "Bengt was adamant that I needed to carry out research in anti-doping matters in the latter half of my day; this to be at the forefront of all anti-doping activities and development. He was right."

It was during this time that Damsgaard first began tracking blood values of elite athletes. "Bengt was simultaneously involved in the WADA and in International Skiing (FIS), and in a split second I found myself reviewing research applications for WADA, creating databases and blood profiles for cross-country skiers among a million of other interesting things."

Damsgaard's skills were in high demand, and he quickly found himself involved in several different organizations. "After Bengt's retirement I took over the anti-doping program within the FIS medical committee. I was asked by the Swedish Anti-Doping Company (IDTM) to become a member of several anti-doping committees within international tennis, weightlifting and archery."

"I owe everything I know about doping to Bengt and his unbelievable amount of knowledge in performance physiology!"

Damsgaard's brave new plan

Damsgaard's entry into professional cycling was a natural progression of his involvement with other sports, and as a result of his outspoken stance on doping in sport. "After the Basso incident I was approached by Bjarne Riis. He wanted to set me straight after some comments I had made in the press; but even more - or even better - he asked me to implement the ultimate and most rigorous anti-doping program the world had ever seen!"

"I decided overnight that this was the chance to change the paradigm of anti-doping work. Personally, I had no objections against it being done within a professional cycling team, as long as it followed every single golden rule of the WADA [World Anti-Doping Agency] Code and on condition that would be totally transparent by publishing the riders' blood profiles for anyone interested to access."

Damsgaard's design wasn't completely new to the sport. Blood profiling had been used before, but the concept hadn't been adopted by WADA. And until recently, despite some French teams performing internal checks after the 1998 Tour de France, most teams had little motivation to implement their own testing programs. But times change, and Team CSC was the first to hire Damsgaard in 2006, and now Astana has also signed on his services.

The program is independent of the teams, and even Damsgaard is not involved in the testing. He instead uses a Swedish laboratory to perform the analysis. "The Swedish Independent Anti-Doping Company IDTM tests the riders in a WADA and ISO 9002 certified manner," he explained. "My only fingerprint is that the collection of tests follows a different mind set than previously used by International Federations (IFs), as I proposed in the anti-doping program that I presented for Bjarne Riis."

"There isn't anything exceptionally new to the program," Damsgaard admitted, noting that the tools the lab uses have been available for a long time. "The uniqueness is the timing, combination of the tests, and interpretation of the results. A well-balanced, increased number of correct tests are applied at the right time to the relevant riders throughout the whole season."

Damsgaard went on to explain why such a rigorous program hasn't already been implemented by other agencies. "The anti-doping community has for many years stipulated that at least 66% of all tests should be collected out-of-competition," he explained. "Out of Competition Tests (OOCT's) are expensive, therefore most of the tests are performed as pre-competition or in-competition "

"But I dare to state that a test collected at a training camp is NOT an OOCT!"

The holes in the individual federations' testing programs result in a less than optimum timing, according to Damsgaard. "The percentage of OOCT's within the different IFs is at best 10%. This leaves a window of opportunity for athletes to use forbidden substances at times during the year where it - even from a physiological point of view - will maximize the performance effect later in the season."

"A genuine doping test is performed unannounced, primarily out-of-competition with proper collection of urine and blood samples of the relevant riders and analysed in either a WADA accredited laboratory or using strictly validated medical equipment."

The program is quite distinct from the 'health tests' which teams already performed on their riders, and is setting the stage for the UCI and WADA's new 'biological passport'.

"Health tests are performed more or less announced, using different collection procedures and analysed using equipment not subjected to proper validation by anti-doping authorities."

Stamp of approval

The strength of the system was backed up by the approval of the UCI in March, 2007, just three months after the start of testing. "I am not familiar with any other teams having their own anti-doping program following these guidelines set and certified by UCI and WADA for urine and some of the blood tests," Damsgaard explained. "You have to follow these guidelines to enable you to say that you have an anti-doping program. If you don't, the program is a health program which is good, but it's got nothing to do with proper anti-doping work."

"The UCI and WADA have received passwords for an internet based database that we had to construct in order to keep track of all the measurements. By doing so the program became more transparent to the most relevant anti-doping authorities."

Damsgaard worked with Team CSC to create a system for testing the riders, and the program took a couple revisions before being rolled out. The program was first announced in September, 2006, but ran into delays after Riis had concerns about whether the team's budget could handle the six-figure price tag. Riis finally approved the program, and released details in December, 2006, calling it the "best anti-doping programme in history".

"To obtain understanding for this approach from the Team CSC riders and the team in general, I have on three occasions made presentations of the work to be done, the progression and finally the conclusion of this first season with the program."

One might expect that riders, who bear the burden of already being subject to doping controls from other agencies, might have objected to additional tests, but according to Damsgaard, the whole team understood quite well why the program was necessary and were willing to cooperate.

"I strongly believe that information is a key element in the prevention of doping and by informing the riders thoroughly, I also believe I pay them my respect," the Dane revealed. "It is after all very intimidating to knock on their door ever so often asking for very sensitive human tissue. I have a desire to show them what results come out of our mutual efforts."

The proof of the pudding...

The final results of the year-long program are yet to be released, but Damsgaard was able to reveal some of the general trends he found in the hundreds of blood samples that went through the program in 2007. "I am in the middle of preparing an annual report including all the individual blood profiles, so the figures have to wait just a little longer."

"Overall, you see a slightly elevated haemoglobin level compared to the normal population. It is, however, lower than observed in some other endurance sports."

"One also finds that the haemoglobin decreases during the season as physiology would normally depict. Also a further significant decrease in haemoglobin levels during the longer stage races is observed," he revealed. "And finally, you see that haemoglobin increases drastically when the season stops - which is likewise expected."

However, the nature of blood work presents its own challenges for comparing numbers over the course of a season. Absolute values can differ from machine to machine and by how the blood is drawn as well as the natural variability that occurs in the human body. "We also found that the blood measurements have to be reviewed over and over again in order to be certain the equipment used was of the highest quality."

"We experienced that the best results were obtained when the same technician analysed the tests on the same mobile analyser brought to the private homes by car - a mobile lab so to speak."

Go on to part two of the interview.