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ROBERT SIEGEL, host:

Dr. Gary Wadler is a clinical associate professor of medicine at New York University. He's also on the World Anti-Doping Agency's Prohibitive List and Methods Committee.

Welcome to the program, Dr. Wadler.

Professor GARY WADLER (New York University): Nice being with you.

SIEGEL: There's been a test of Floyd Landis's urine showing that he had an elevated ratio of testosterone to epitestosterone. He says flatly that he didn't do any doping. Will the second test be able, first of all, to prove him right or possibly disprove him?

Dr. WADLER: Well, there's two second tests that we're talking about. The first one is the so-called B specimen, which, as Mr. Landis suggests, will probably confirm the first finding. The second alternative, which I suspect is being done in this case, will address the question of whether he has an unnatural substance in his body that he had used.

That's the so-called CIR test, which is a carbon isotope ratio spectrometry test, which is able to distinguish natural testosterone, that which occurs normally within the human body, from that which is manufactured for therapeutic purposes and comes to us in bottles and other forms of delivery systems.

So at the end of the day, the TE ratio sort-of triggered the investigation, but the ultimate test, it seems to me, will be reside in the word natural or unnatural in terms of the CIR. That is, what was in his urine? Was it pharmaceutical or was it physiological?

SIEGEL: Could there be an elevated ratio of testosterone to epitestosterone, this is the T to E ratio, I gather, that was entirely natural and would be a sign of nothing especially wrong?

Dr. WADLER: Well, typically there's a longitudinal history and certainly he has been tested numerous, numerous times in the course of his career and one would have expected an aberration to have shown up if it was based on a natural variation that could then be explained. So the fact that there is no history of elevated TE ratios in the past certainly makes this stand out inexplicably.

There's nothing that I know of that would raise it as much as it has been suggested, although none of us actually have the number, but apparently it's been a rather substantial elevation, and I'm not aware of anything aside from doping that would do that.

SIEGEL: Let's deal with some possible explanations of what happened here. First, is it possible that there can be a false positive or, if both the A and the B sample come back with an elevated ratio, does that mean something must be at work there in his system.

Dr. WADLER: If the B sample confirms the A, then I would certainly accept that as indicating there was an elevated TE ratio.

SIEGEL: Could there be any substance ingested that was not synthetic testosterone but something else that might create an increased presence of testosterone.

Dr. WADLER: Well there are some things that can cause some moderate variations, such as alcohol. But the order of magnitude of change that occurred in this situation far exceeds anything that I'm familiar with in terms of ingesting anything that would cause this to occur other than testosterone.

SIEGEL: He's admitted to some partying the night after that bad phase of the Tour de France, some Jack Daniels, some other - but you're saying alcohol alone wouldn't do that.

Dr. WADLER: Alcohol has been shown to cause some ups and downs in the test, but not in the order of magnitude we're talking about. We're talking about extreme elevations. But even given that there can be such variations, the ultimate proof will be in the pudding because if it turns out this is pharmaceutical testosterone, you know, there's no further discussion except what the consequences will be to him.

SIEGEL: Dr. Wadler, thank you very much for talking to us.

Dr. WADLER: Nice being with you.

SIEGEL: That's Dr. Gary Wadler of New York University Medical School, who is on the World Anti-Doping Agency's Prohibited List and Methods Committee.

NPR sports correspondent Tom Goldman answers questions about the doping allegations at NPR.org.

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