CASE 007
:
THE CASE OF THE FALLEN CHAMPION
She crossed the finish line first and broke a world record. Twenty minutes later her medal was taken away. The test said she had cheated. She says the test is wrong. One urine sample. One failed reading. And a sports scientist who believes the numbers tell a completely different story.
CASE BRIEFING
At 2:34 PM on a Sunday in September, Amara Osei crossed the finish line of the 1500 metre final at the International Athletics Championships in a time of 3 minutes 47.2 seconds.
A world record.
The crowd erupted. Amara collapsed to her knees on the track. She had been training for this moment for eleven years.
Twenty minutes later a doping control officer was waiting for her outside the medical tent.
Standard procedure. Amara cooperated without hesitation.
The sample was sealed, coded, and sent to the World Athletics accredited laboratory in Zurich.
Nine days later the result arrived.
Amara Osei had tested positive for EPO — erythropoietin — a hormone that stimulates the production of red blood cells, increasing the amount of oxygen muscles can carry and significantly enhancing endurance performance. EPO is on the World Athletics prohibited substances list. Its use constitutes a doping violation.
Amara's world record was suspended. Her medal was confiscated. She faced a four-year ban from competition.
She denied everything.
"I have never taken EPO. I have never taken anything prohibited. I have been tested forty-seven times in my career and never once failed. Something is wrong with this result."
Her coach — Dr. Felix Adeyemi, a former exercise physiologist at the University of Lagos — went further.
"I have trained Amara for nine years. I know her physiology better than anyone. The numbers in that test result are not consistent with exogenous EPO use. They are consistent with something else entirely — something completely natural. The laboratory has misread what the science is telling them."
The World Athletics Disciplinary Tribunal appointed an independent sports scientist — Dr. Ingrid Solberg of the Norwegian Institute of Sport Science — to review the case.
Her review took three weeks.
When it was complete she requested an urgent meeting with the Tribunal.
"Before this panel makes a final decision," she said, "I need them to look at five things."
Your investigation begins now.
A world record. A positive test. A coach who says the science has been misread. And a sports scientist who believes something important has been missed.
Examine all five Evidence Files. The laboratory result is not in dispute — EPO was detected. What is in dispute is what that detection actually means — and whether the numbers tell the story everyone has assumed they tell.
The science of human physiology is more complex than a single positive test. Can you determine what really happened to Amara Osei?
Instructions:
Play solo or with a team of up to 5 investigators. Examine the five Evidence Files together, or divide them among your team and have each investigator analyze different clues. Share what you discover, compare theories, and decide which evidence matters most.
When you've examined all the evidence, work individually or as a team to reach your final verdict—then reveal the solution to see if you cracked the case.
EVIDENCE FILES
EVIDENCE FILE 01 +
EVIDENCE FILE 01 — DOPING CONTROL LABORATORY REPORT
Case Reference: WAT-2024-0917
Sample Code: DC-4471-OSE
Athlete: Coded — identity withheld from laboratory during analysis
Sample Type: Urine — A sample
Collection Date: Sunday — 2:54 PM
Laboratory: World Athletics Accredited Laboratory — Zurich
Report Date: Nine days post-collection
BACKGROUND
All athletes finishing in the top three of a World Athletics Championship final are subject to mandatory doping control. Additional athletes are selected at random. Amara Osei was tested as a top-three finisher.
The sample was collected under direct observation, sealed with tamper-evident packaging, assigned a code number, and transported to Zurich under documented chain of custody. The athlete's identity was not known to the laboratory during analysis.
TEST METHOD — EPO DETECTION
Erythropoietin — EPO — is a hormone produced naturally by the kidneys in response to low oxygen levels. It stimulates the bone marrow to produce red blood cells. More red blood cells means more oxygen delivered to working muscles — a significant performance advantage in endurance sports.
Synthetic EPO — produced pharmaceutically — is chemically similar to natural EPO but differs in one detectable way. When EPO is produced in the body it is glycosylated — sugar molecules are attached to the protein — in a specific natural pattern. Pharmaceutical EPO is glycosylated differently during its manufacturing process.
The test used — isoelectric focusing combined with immunoblotting — separates EPO molecules by their electrical charge and identifies the specific glycosylation pattern. Natural EPO and synthetic EPO produce different banding patterns on the test result.
LABORATORY FINDING
The isoelectric focusing analysis of sample DC-4471-OSE produced a banding pattern that the laboratory classified as positive for exogenous EPO.
The result was reviewed by two independent laboratory scientists before being reported.
Both reviewers confirmed the classification.
WHAT THIS FINDING ESTABLISHES
The laboratory result establishes that the banding pattern observed in this sample was classified as consistent with exogenous — externally administered — EPO.
WHAT THIS FINDING DOES NOT ESTABLISH
The test identifies a banding pattern. It does not measure the quantity of EPO present. It does not establish when the substance was administered. It does not account for physiological conditions that may affect the natural EPO banding pattern.
YOUR TASK
The laboratory found a banding pattern consistent with exogenous EPO in Amara Osei's sample.
Two scientists reviewed and confirmed the result.
But read the laboratory note carefully — particularly what the test does not establish.
The test identifies a pattern. It does not measure quantity. It does not account for physiological variables.
Research how EPO testing works and what conditions — natural or medical — might affect the banding pattern the test relies on. Consider what questions the laboratory result alone cannot answer — and what the remaining evidence files will need to establish.
EVIDENCE FILE 02 +
EVIDENCE FILE 02 — ATHLETE BIOLOGICAL PASSPORT
Case Reference: WAT-2024-0917
Document Type: Longitudinal haematological profile
Athlete: Amara Osei
Period Covered: Eight years of competitive testing
Prepared By: Dr. Ingrid Solberg, Norwegian Institute of Sport Science
BACKGROUND
The Athlete Biological Passport — ABP — is a long-term monitoring system used by World Athletics and other sporting bodies. Rather than testing for specific prohibited substances at a single point in time, the ABP tracks an athlete's key biological markers over months and years — building an individual physiological profile.
The principle is straightforward: natural biological values fluctuate within a personal range. If values suddenly move outside that established range — particularly in ways consistent with doping — the passport flags an anomaly.
Dr. Solberg reviewed Amara Osei's complete ABP spanning eight years and 47 previous tests.
KEY MARKERS TRACKED
Haemoglobin concentration — the amount of oxygen-carrying protein in the blood. EPO use increases haemoglobin by stimulating red blood cell production.
Reticulocyte percentage — reticulocytes are immature red blood cells freshly released from the bone marrow. A sudden spike in reticulocytes indicates recent stimulation of red blood cell production — a key indicator of EPO use.
OFF-score — a composite calculation combining haemoglobin and reticulocyte values. High OFF-scores indicate suppression of natural red blood cell production — consistent with the body's response after exogenous EPO use ceases.
AMARA OSEI — EIGHT YEAR PROFILE
Dr. Solberg summarised her findings as follows:
Haemoglobin concentration across 47 tests: consistently between 13.8 and 14.6 g/dL — stable, narrow personal range with no sudden elevations.
Reticulocyte percentage across 47 tests: consistently between 0.8% and 1.4% — within normal physiological range throughout.
OFF-score across 47 tests: consistently within expected parameters — no suppression patterns detected at any point.
Values recorded at the championship competition:
Haemoglobin: 14.1 g/dL — within her established personal range
Reticulocyte percentage: 1.1% — within her established personal range
OFF-score: within expected parameters
DR. SOLBERG'S OBSERVATION
"In eight years of testing Amara Osei's haematological profile has shown remarkable consistency. There is no point in her passport where her values suggest intervention — no haemoglobin spike, no reticulocyte surge, no suppression pattern. Her values on the day of competition are entirely consistent with her established baseline.
If she had used EPO in the weeks before competition I would expect to see evidence of it in these markers. I do not."
YOUR TASK
The laboratory test identified a banding pattern consistent with exogenous EPO.
The Athlete Biological Passport shows eight years of stable haematological values — with no markers consistent with EPO use at any point including the competition itself.
These two pieces of evidence appear to contradict each other. How is it possible for a test to show exogenous EPO while the biological passport shows no haematological evidence of its effect?
Research what EPO actually does to the body's blood markers over time. Consider what would happen to haemoglobin and reticulocyte levels if EPO had genuinely been used in the weeks before competition — and whether those effects are visible here.
If the passport shows none of the expected physiological consequences of EPO use — what does that tell you about the laboratory result?
EVIDENCE FILE 03 +
EVIDENCE FILE 03 — TRAINING AND ALTITUDE RECORD
Case Reference: WAT-2024-0917
Document Type: Training log and altitude exposure record
Athlete: Amara Osei
Period Covered: Sixteen weeks pre-competition
Prepared By: Dr. Felix Adeyemi, Head Coach
BACKGROUND
EPO — whether natural or synthetic — stimulates red blood cell production by signalling the bone marrow to increase output. The body produces EPO naturally in response to reduced oxygen availability — most commonly at high altitude where the air contains less oxygen per breath.
Athletes who train at altitude — or sleep in altitude simulation tents — legitimately elevate their natural EPO levels and increase red blood cell production as a result. This is not prohibited. It is a well-established legal performance enhancement method used by elite endurance athletes worldwide.
The distinction the test attempts to make is between EPO produced naturally by the body and EPO introduced from an external pharmaceutical source.
Dr. Adeyemi submitted Amara Osei's complete training and altitude record for the sixteen weeks preceding the championship.
TRAINING CAMP — WEEKS 1 TO 10
Location: Iten, Kenya — elevation 2,400 metres
Amara Osei completed her primary pre-competition training block at the high altitude training facility in Iten — one of the most established altitude training camps in world athletics.
Duration at altitude: 70 consecutive days
Average daily training load: High — two sessions per day, six days per week
Altitude exposure: Continuous — living and training at 2,400 metres throughout
Physiological effect of 70 days at 2,400 metres: sustained elevation of natural EPO production, progressive increase in red blood cell mass, haemoglobin adaptation.
RETURN TO SEA LEVEL — WEEKS 11 TO 16
Amara Osei returned to sea level six weeks before the championship for final race preparation and competition sharpening.
At sea level the stimulus for elevated natural EPO production is removed. The body gradually normalises. Red blood cell mass begins to decrease. Haemoglobin concentration stabilises.
However — the transition from altitude to sea level is not instantaneous. Physiological adaptation continues for weeks after return.
CRITICAL DETAIL — COMPETITION DAY
The championship took place exactly 42 days after Amara Osei descended from altitude.
Dr. Adeyemi noted one specific physiological consequence of this timing.
During prolonged altitude exposure the body's EPO production is chronically elevated. The glycosylation pattern of naturally produced EPO can be altered by sustained high-altitude exposure — the cellular machinery producing EPO under chronic hypoxic stress operates under different conditions than at sea level.
"At 42 days post-altitude Amara's natural EPO glycosylation pattern may not have fully normalised to its sea-level baseline. The test assumes a standard sea-level natural EPO pattern. If her natural EPO still carried residual altitude-modified glycosylation characteristics — the test may have misclassified it."
YOUR TASK
Amara Osei spent 70 consecutive days at 2,400 metres elevation — legally and documented — before returning to sea level 42 days before competition.
Research what prolonged altitude exposure does to natural EPO production and glycosylation. Consider whether the isoelectric focusing test described in Evidence File 01 could misclassify naturally produced EPO that has been altered by sustained altitude exposure.
The laboratory test distinguishes natural from synthetic EPO by glycosylation pattern. Dr. Adeyemi is suggesting that prolonged altitude exposure may alter the natural pattern sufficiently to produce a false positive.
Is this scientifically plausible — or is it an explanation constructed after the fact to avoid a doping ban? What evidence would confirm or contradict it?
EVIDENCE FILE 04 +
EVIDENCE FILE 04 — INDEPENDENT PHYSIOLOGICAL ASSESSMENT
Case Reference: WAT-2024-0917
Document Type: Expert physiological review
Prepared By: Dr. Ingrid Solberg, Norwegian Institute of Sport Science
Date: Eighteen days post-positive result
BACKGROUND
Following her review of the Athlete Biological Passport and training records, Dr. Solberg commissioned an independent physiological assessment of Amara Osei — examining whether her race performance and post-race biological values were consistent with natural athletic development or with EPO enhancement.
The assessment addressed one central question:
"Is the performance Amara Osei produced on competition day consistent with her established physiological profile — or does it require an external explanation?"
PERFORMANCE ANALYSIS
Amara Osei's progression over eight years of competitive results:
Season 1: Personal best — 4 minutes 02.1 seconds
Season 3: Personal best — 3 minutes 56.4 seconds
Season 5: Personal best — 3 minutes 52.8 seconds
Season 7: Personal best — 3 minutes 49.1 seconds
Season 8 — championship: 3 minutes 47.2 seconds
The improvement trajectory shows consistent, progressive development over eight years — an average improvement of approximately 2.2 seconds per year.
The championship performance — 3 minutes 47.2 seconds — represents an improvement of 1.9 seconds over her previous personal best.
Dr. Solberg noted: "A 1.9-second improvement at world record level is significant but not extraordinary. It is consistent with an athlete peaking at the right moment after an optimal preparation block. It does not require a pharmacological explanation."
VO₂ MAX ANALYSIS
VO₂ max — the maximum rate at which an athlete's body can consume oxygen during intense exercise — is the primary physiological determinant of endurance performance.
Amara Osei's VO₂ max has been measured regularly throughout her career:
Season 1: 62.4 ml/kg/min
Season 4: 68.1 ml/kg/min
Season 6: 71.3 ml/kg/min
Season 8 — six weeks pre-competition: 74.2 ml/kg/min
The progression is consistent and linear. The Season 8 value of 74.2 ml/kg/min is high for a female middle-distance runner but within the documented range for elite athletes at this level.
Dr. Solberg noted: "Her VO₂ max progression follows a natural development curve. There is no sudden unexplained jump that would suggest pharmacological intervention."
POST-RACE CORTISOL AND TESTOSTERONE VALUES
Blood samples taken 30 minutes after the race as part of standard medical monitoring showed:
Cortisol: elevated — consistent with extreme physical exertion
Testosterone to epitestosterone ratio: within normal parameters
Lactate clearance rate: consistent with her established post-race profile
No biological marker in the post-race panel was outside Amara Osei's established personal range.
B SAMPLE STATUS
Under World Athletics rules an athlete who tests positive on the A sample may request analysis of the B sample — a second portion of the same urine collection sealed separately at the time of collection.
Amara Osei requested B sample analysis immediately upon notification of the A sample result.
The B sample analysis was conducted by a second accredited laboratory in Paris under blind conditions.
B sample result: positive for the same banding pattern identified in the A sample.
DR. SOLBERG'S ASSESSMENT
"The B sample confirmation means the laboratory finding is reproducible — the same banding pattern appears in both portions of the same collection. This rules out laboratory error in sample handling or analysis.
However — reproducibility confirms the banding pattern is real. It does not confirm its cause. If the A sample banding pattern reflects altitude-modified natural EPO rather than exogenous EPO — the B sample would show the same pattern, because both samples came from the same athlete at the same physiological moment.
The question is not whether the banding pattern exists. It does. The question is what produced it."
YOUR TASK
The B sample has confirmed the banding pattern. Laboratory error is ruled out.
The performance progression and VO₂ max trajectory show consistent natural development with no unexplained jumps.
The post-race biological panel is entirely within Amara's established personal range.
Consider what the B sample confirmation means — and what it does not mean. Then consider the complete picture: a consistent biological passport, a natural performance trajectory, a documented altitude training block, and a banding pattern that two laboratories have now confirmed.
Is the banding pattern evidence of doping — or evidence of something the test was not designed to account for? What single piece of evidence would definitively resolve this question one way or the other?
EVIDENCE FILE 05 +
EVIDENCE FILE 05 — GLYCOSYLATION RESEARCH AND EXPERT PANEL FINDINGS
Case Reference: WAT-2024-0917
Document Type: Scientific literature review and expert panel conclusion
Prepared By: Dr. Ingrid Solberg, Norwegian Institute of Sport Science
Date: Twenty-one days post-positive result
BACKGROUND
Following the B sample confirmation and physiological assessment, Dr. Solberg commissioned a targeted review of published scientific literature on EPO glycosylation patterns under conditions of prolonged altitude exposure.
The central question: is there peer-reviewed scientific evidence that naturally produced EPO — following sustained high altitude exposure — can produce isoelectric focusing banding patterns that overlap with or resemble exogenous EPO patterns?
LITERATURE REVIEW FINDINGS
Dr. Solberg identified seven peer-reviewed studies directly relevant to the question.
Key finding 1:
A 2019 study published in the International Journal of Sports Physiology and Performance examined EPO isoelectric focusing patterns in 24 elite endurance athletes before, during, and after a 21-day altitude training camp at 2,200 metres.
The study found that in 6 of 24 athletes — 25% — the isoelectric focusing pattern of naturally produced EPO showed measurable shifts toward the acidic range after sustained altitude exposure — the same directional shift associated with exogenous EPO.
The authors noted: "Current isoelectric focusing methodology may not adequately distinguish altitude-modified endogenous EPO from exogenous EPO in all cases. Athletes with prolonged hypoxic exposure represent a population where false positive classification cannot be excluded."
Key finding 2:
A 2021 study from the University of Copenhagen examined EPO glycosylation specifically at 42 to 50 days post-altitude descent — precisely the window relevant to Amara Osei's case.
The study found that glycosylation normalisation following altitude exposure is not linear — in some individuals residual glycosylation modification persists beyond 40 days post-descent, particularly following exposures exceeding 60 days at elevations above 2,000 metres.
Amara Osei's exposure: 70 days at 2,400 metres. Days post-descent at competition: 42 days.
Both parameters place her within the at-risk population identified by the Copenhagen study.
Key finding 3:
A 2022 World Anti-Doping Agency internal review acknowledged the altitude-EPO glycosylation question directly:
"The current isoelectric focusing methodology was validated primarily against sea-level athlete populations. The methodology's specificity in athletes with recent prolonged altitude exposure has not been comprehensively validated. This represents a gap in the current testing framework that warrants further research."
EXPERT PANEL CONCLUSION
Dr. Solberg presented her complete findings to a three-member expert panel convened by the World Athletics Disciplinary Tribunal — comprising a haematologist, a sports pharmacologist, and an exercise physiologist. None had prior involvement in the case.
The panel's unanimous conclusion:
"The scientific evidence presented demonstrates that the isoelectric focusing test used to identify exogenous EPO has not been validated for athletes with recent prolonged altitude exposure of the duration and elevation documented in this case.
The banding pattern observed in Amara Osei's sample is real and reproducible. However the scientific literature identifies a plausible natural mechanism — altitude-modified EPO glycosylation — that could produce an identical or similar pattern in a small but documented proportion of athletes.
In the absence of corroborating haematological evidence of EPO use — which is not present in this athlete's eight-year biological passport — and in the presence of a documented altitude exposure consistent with the proposed natural mechanism, the panel cannot conclude with the scientific certainty required for a doping violation that the banding pattern in this case reflects exogenous EPO administration."
YOUR TASK
You now have all five Evidence Files.
The laboratory detected a banding pattern consistent with exogenous EPO — confirmed in both A and B samples.
The biological passport shows eight years of stable haematological markers with no evidence of EPO's physiological effects.
The performance trajectory shows consistent natural development with no unexplained jumps.
The training record documents 70 days at 2,400 metres — returning to sea level exactly 42 days before competition.
The scientific literature identifies a documented natural mechanism — altitude-modified EPO glycosylation — that can produce the same banding pattern in a proportion of athletes with prolonged high-altitude exposure.
Using all five Evidence Files — did Amara Osei cheat? Build your case using the science, the passport data, the performance record, and the literature findings. Which evidence is most conclusive — and what does the gap between what the test detected and what the passport shows tell you about the limits of a single laboratory result?
HAVE YOU SOLVED THE CASE?
Review the evidence and decide what you think happened. If you're investigating with others, discuss your findings and agree on your final verdict before revealing the answer.
Once your team has reached a conclusion, reveal the answer.