Parisotto - Final Response

10 Oct 2012

As usual, you can find Parisotto's article here:

At the end of a long discussion, Parisotto is forced to amend his "absolute certainty of blood manipulation" about Lance Armstrong's Biological Passport data. 

Reaffirming his adopted criterion "it is the variability of measures, the magnitude of the changes, and the timing of the changes that are key to forming an OPINION" (criterion of which there is NO trace in WADA's technical documents), Parisotto concludes: 

"This case would be classified as Doping Suspicious”. 

Instead of clarifying how big the changes or significant the variations in the parameters, Parisotto dwells in considerations abounding conditional tenses, "subjective opinions about data" and an undefined "balance of probability" to suggest or support a suspicion of doping in front of "three experts" who are, like him, involved in the Biological Passport project and therefore not independent. 

With regards to the lack of a decrease in Hb during the 2009 TdF, I observe:

- data available in the literature are conflicting and non-univocal. I shall simply remind the results from a recent study (Clin Chem Lab Med 2012,50:949-956) that shows how in of a group of nine participants in the Giro 2011 from Team Liquigas, the Hb values of one cyclist did not decrease in the measurements taken from the start to the finish of the race (see Figure 2 on page 952), and actually in four athletes Hb increased from day 12 to day 22 of the race. 
Assimilating a lack of "expected behavior" with "suspicion of doping" is permissible but questionable and risky. This claim to assess (and sanction) the behavior of the individual by comparing it with those of the majority of the athletes is wrong, especially when using clinical haematological parameters such as Hb and %ret 

- the concentration of Armstrong's Hb at ​​the beginning of TdF (14.3) is lower than his previous average values ​​(Hb = 14.8) and the one at the beginning of the Giro (14.8): it is possible that Armstrong had trained intensely in the days immediately prior to the start of the TdF, thus diluting his values ​​of Hb already at the beginning of the race; the reason is an increase in plasma volume due to the efforts before the Tour. 
Affirming that "Hb is truly increasing" during the 2009 TdF does not reflect a careful and critical evaluation of the available data; just as arguing that a reduction of 0.2% in reticulocytes is significant of anything simply brings a smile on the lips of every hematologist or laboratory expert. 

About the relationship altitude-reticulocytes: if there was an increase in Hb mass after 16 days at altitude it is normal that the reticulocyte response is attenuated in the following weeks, even without mentioning "aplastic anemia", "space travel" or "previous doping practices". 
Parisotto's statement "Following return from altitude exposure the body would be busily restoring hemopoietic balance by producing more reticulocites" is the exact opposite of what happens and is reported in literature.