Cheat sheet A guide to doping on Tour de France

Every evening as their bicycles zipped across the day's finish line, drained Tour de France cyclists with gaunt faces and sweat-soaked hair matted under their helmets would slide off the seats they had been riding through the French countryside.

Their bodies were drained of liquid, their muscles depleted of potassium and filled with carbonic and lactic acid.

While support staff from the teams gathered bikes and equipment to get ready for the next morning's run, the riders would stuff themselves with food and liquid, then retire to another phase of the race.

Some cyclists would take sterile bags and syringes out of packs and drain some of their blood to store overnight. They would take testosterone patches and place them on the scrotum to quickly absorb the rejuvenating hormone. Some would take a daily dose of growth hormone, or insulin, or insulin-like growth factor, or T3 thyroid medication, or epinephrine, all of which are nearly impossible to test for.

After a few hours, the testosterone patch comes off. Seven to nine hours later, the drug will be at peak effectiveness, and after 14-18 hours, it's out of the system altogether. Then a night's rest, pump the blood back into the body, back on the bike.

And off to do things that the human body should not be able to do. If the system is followed to the letter, none of these performance-enhancing tactics should ever be detected.

"When you get to that level, you know how to play this game," says sports medicine physician John Sonzogni, the former team physician for the New Jersey Nets, assistant team doctor for the New York Giants and the medical director for both a men's and women's World Cup. "It's the same with the NFL, same with Major League Baseball: they know when to bring (their drug levels) back down."

The nightly drug routine was provided to the New York Daily News by a former steroid dealer who spoke on the condition of anonymity, and several physicians who looked it over say it makes perfect sense. But as Tour de France winner Floyd Landis prepares to appeal his failed drug test, his saga has again exposed how easy and pervasive cheating is in cycling, just as sprinter Justin Gatlin's failed test has done in track and field.

Landis and sprinter Gatlin may have screwed up and been caught, anti-doping advocates and medical experts say, but they are hardly the only ones to cheat in their sports.

"One other thing that's happening now is that people are realizing the tests are not all that great," says Don Catlin, the director of the UCLA Olympic lab and the man who more or less invented anti-doping tests. "I know that, but I don't walk around advertising it."

He doesn't need to. The athletes know it all too well.

Catlin told the Daily News earlier this year he is so convinced that testing does not work that he wants to create a "volunteer" program, in which athletes could have themselves screened before they reach the elite level, giving testers a baseline to which they could compare all future tests. As long as an athlete stays clean, he or she will keep the Don Catlin seal of approval. If the numbers change at all, then a committee of the athlete's peers could decide to expel the person from the program. If someone was dirty during the initial screening, it would be nearly impossible to maintain the same numbers for the rest of his or her professional life.

The program is only in the planning stages, but in light of the Landis and Gatlin embarrassments, Catlin says more colleagues are urging him to secure funding and get it going.

It's needed, some anti-doping advocates say, especially in a sport such as cycling where experts and even some cyclists say it is not possible to compete at the elite level without doping.

"I don't think it is," says Lewis Maharam, a sports medicine physician and the past president of the New York chapter of the American College of Sports Medicine. "People look at it like it's fake, and it's killing (the sport)."

Simply put, medical experts say, the body cannot recover on its own quickly enough during a competition as grueling as the Tour de France has become and not at the speeds the cyclists now race. To keep the body from breaking down, they need drugs such as testosterone, growth hormone and insulin for repair, and drugs like erythropoietin to increase red blood cell production.

The steroid dealer interviewed by the Daily News, who has not worked with Landis, says he suspects that Landis was wearing a testosterone patch and forgot to remove it after a night of drinking, which could explain "why his number would be through the roof like that."

Maharam said it is also possible that Landis was using both testosterone and epitestosterone to beat the ratio test. The magic of BALCO's famous "cream" was that it contained both hormones, so the athlete would get additional testosterone but his or her testosterone to epitestosterone ratio would remain the same. Some athletes using testosterone inject themselves with epi-t just below the nipple, where the needle mark won't be noticeable. It's possible, Maharam says, that Landis was using both drugs but simply ran out of the epitestosterone.

"It's needed for added recovery and to get some killer instinct and aggressiveness," he says. Maharam says he thinks Landis may have been "arrogant and stupid and thought he wasn't going to be tested."

Most sophisticated cheaters know the testing protocols and have adapted their doping regimens as needed. In the Tour de France, the tour leader, stage winner and three random riders are tested, and Landis may not have expected to actually win the stage.

Not all steroid testing programs are identical, but they share some basic features. A league collects samples and sends them to a lab such as Catlin's. The lab puts the urine into two vials, an "A" and "B" sample, and begins testing the "A" in a mass-spectrometer. The machine looks for all known steroids _ each has a distinct pattern _ and compares the amount of testosterone to epitestosterone. Because the average person's body produces both in the same amounts, if the testosterone level is four times greater than the epitestosterone, it is considered a positive test. That 4-1 t/e ratio, as it is known, is the test that both Landis and Gatlin failed. (The same steroid dealer the Daily News interviewed says it is likely that anti-doping was tipped off about Gatlin's regimen, so agents would know to test him when the levels were at their maximum.)

Once the t/e level is tripped, most sports leagues and federations _ including almost every one of Catlin's clients _ then have the lab do a carbon-isotope ratio (CIR) test, which can determine whether the athlete has used synthetic testosterone. Landis failed that test, too. The NFL and Major League Baseball opt for the CIR test only if testers think there is something fishy with the sample.

The only exception, Catlin says, is the U.S. Anti-Doping Agency, which occasionally sends samples to be tested specifically for the carbon-isotope ratio, regardless of whether that sample was suspicious or not. By doing that, USADA has a chance to catch cheats who are taking testosterone, but keeping their levels low enough to avoid detection. Catlin says his lab is working on a study to see how many samples that are under the 4-1 ratio have synthetic testosterone in them.

"We're using strategies that are most effective for testing, and we've learned through situations like BALCO and the other information we receive that you sometimes have to be efficient, be effective and alter some of the testing that you're doing," says USADA senior managing director Travis Tygart.

As for the sports that don't let USADA or the World Anti-Doping Agency run their testing, "you hope the paradigm shifts to an independent entity that does it because it's real hard for a sport to promote and police itself at the same time," he says.

NFL and MLB representatives say they are happy with their current systems.

"We're always concerned that any substance that has a natural component in the body ... that there are ways to avoid detection," says Adolpho Birch, the NFL's counsel for labor relations. "We feel pretty comfortable that ... we will get the vast majority of people who are cheating. Overall it's a good system."

Rob Manfred, MLB's vice president for labor relations and human resources, says baseball is open to new testing procedures, but comfortable with its current system.

"It may be that at some point in the future that may be an appropriate addition to the program," he says.

Both men point to another reality about the CIR test: it is more expensive than the normal assay the labs do. At UCLA, a CIR test costs about $300-$325 per sample, and other labs charge as much as $550. A standard assay, which searches for about 250 drugs, costs only $150, Catlin says.

For the NFL, which spends roughly $1.5 million per year on just the initial 10,000 screens it does, would pay another $3 million to $3.25 million for CIR tests at the current prices.

But if more organizations used the CIR test in bulk, "I think then the price would begin to come down," Catlin says.

While his clients seem content with the current system, Catlin says the sagas of Landis and Gatlin might influence the press and public to push for more testing. It's a slow learning curve for everyone, he says.

"One of the things that's going to happen from the cases that are floating around out there is, I suspect, more requests for CI ratios. I can feel it already," Catlin says. "Everybody sort of understands what a drug test is for marijuana, or the layperson has an idea, but when you start talking about carbon-isotopes and atoms, they really tune out, and it happens with clients as well. These organizations are not run by chemistry professors. The world would be a different place if they were."

Catlin says he understands why sports leagues are reluctant to spend more money on a test that will catch more of their athletes than if they administer their own testing, the way MLB and the NFL do. He is asked if he fears that leagues just want enough testing to put up a good front.

"Yeah, you can't help but worry about that if you go walking around thinking about it," he says. "What sport-minded person wants to read about his player having a positive test? It's the last thing he wants."

But Catlin maintains his faith that all sports will realize their credibility is at stake.

"My philosophy is I don't worry about that. I don't try to convert anybody," he says. "I think what we can do can stand on its own, and in due course, if that's somebody's view, it'll change."