Parisotto - Part III
As usual, you can find Parisotto's article here:
It is rather pointless of Robin Parisotto to try and "climb on mirrors": the fact of the matter is his statement "Armstrong's blood values are UNDOUBTELY indicative of blood manipulation".
Such a grave and peremptory accusation, even more so when he is the one to admit that he has not been in possession of all the information needed to reach such conclusion.
His illustrious Colleagues, Morkeberg and Damsgaard, quoted by the same Parisotto, have been much more cautious in their judgments, not to mention the equally authoritative opinion of an academic (Prof. Heier, President of International Soc. Blood Transfusion), who is not involved in the "Biological Passport" and who excludes that the profile is compatible with blood doping.
It is not necessary for Parisotto to spend time in illustrating the rules of WADA's Athlete Biological Passport: we know the contents by heart.
In particular, with regards to the altitude correction factor: it does not matter whether we consider the predictive value rather than the recorded value: the end result is the same, spreading the "gap tolerance" marked in red in the ABP profile.
And Armstrong's values are ALL inside this gap, as confirmed by the same Damsgaard.
Parisotto reaffirms the evaluation criteria (and Judgement) adopted by the "Biological Passport": "a Subjective assessment of the pattern". A policy that leaves too much scope for interpretation and therefore errors and flaws of assessment.
With regards to the questions in Point 5, my response is: THE BODY CHANGES.
The adaptive responses to apparently similar stimuli, such as a Giro and a TdF, can be very different because there are dozens of external and internal (to the body) factors that can change from one event to the other, as every MD should be able to understand when considering the blood tests of each individual patient.
The Hb concentrations depend primarily on changes in plasma volume related to TRAINING, FATIGUE, REST, STRESS, NUTRITION (intake of sodium in particular), HYDRATION, ALTITUDE.
A variation in the concentration of Hb does not necessarily mean a change in the hemoglobin mass.
The reduction in reticulocytes (around 0.2%) evoked by Parisotto is not significant: the average value of the six tests during the TdF 2009 is 0.61%, which is perfectly compatible with a previous period of 26 days at altitude.
Just as the reticulocytes in the tests dated 16th and 17th of June (0.64 and 0.74), collected after 16 days of altitude-induced hypoxic stimulus, correspond to a slowdown in the hematopoietic response subsequent to the increase in the concentration of Hb (16.0).
Finally, comparing the reticulocytes values of October 16th 2008 (when Armstrong was at rest, having just returned to cycling from three years of beers and jogging) with the values collected during the 2009 Giro helps me to understand Parisotto's approach to the data of the "Biological Passport".