Friday, January 25, 2013

Lance and Dr. Ferrari Disagree: Winning the Tour Required Doping?

You may have heard Lance assert to Oprah that winning the Tour without doping would have been impossible.

Most cyclists probably agree with Lance on this, but the reaction from some of the world's experts has not been unanimous.

Even Lance's doping expert has since come out against Lance on this issue; yesterday Michelle Ferrari stated "Armstrong would have achieved the same level of performance without resorting to doping, also thanks to his talent which was far superior to the rivals of his era."  Ferrari argues that taking EPO or blood transfusions to increase his Hb mass (i.e., his red blood cell count, or haemoglobin) by 5-10% only increased Lance's performance "in the order of 3-6%."  Furthermore, had Lance been less rooted to living at sea level he could achieved that same Hb mass increase simply with altitude training.

Raise Hb mass, Ferrari implies, and you raise power output.  

This assertion about increasing the Hb mass leading to going faster seems even more of a given than Lance's assertion--that doping was necessary--but it isn't.  Dutch researchers now dispute that.  They argue, in a recent publication in the very scholarly British Journal of Clinical Pharmacology, that there is no evidence that EPO improves performance in world class athletes.  Other conclusions assertions:
  • Increased Hb mass improves performance in most people ("a haemoglobin increase irrespective of baseline haemoglobin levels will increase maximal aerobic power and therefore performance" in most people);
  • Blood transfusion increases Hb mass in most people;
  • Elite athletes are not most people.  Specifically, while most people go faster when their Hb mass goes up, elite athletes don't.  Or as the authors state, improved VO2max "has a very limited predictive value for endurance performance within a group of high-performance athletes."
This incredible excepting of elite athletes from the laws that govern the rest of us (EPO may work for most people, but not necessarily for elite athletes) is not based on any new research, but on a "qualitative systematic review of available literature." 

Response
This literature review--I'm not going to call it a "study," as several publications have--has been cited by dozens of major publications, including the Washington Post, as evidence that, hey, maybe the joke's on us.  Lance would've won those races anyhow.  Poor guy.  Dr. Ferrari misled him!  And here he thought he had to dope!    

1. Lance
It struck me as odd that among the pieces of literature the Dutch researchers use to argue that elite cyclists are unaffected by EPO is this  incredibly controversial (delusional and methodologically flawed are probably more apt adjectives) study on Lance.  Even the NY Times, pre-Lance/Oprah, noted the study's flaws.

Coyle's paper argues that Lance is faster because he's more efficient.  Coyle sort of has to argue this, because Lance's VO2max and his lactate threshold don't show appreciable improvement, and yet his power keeps going up--15% up over 7 years.

As a paper, Coyle's analysis of Lance is a mess.  He comes to strange conclusions, and he even uses the wrong formulas to determine efficiency.  It's unclear whether he intentionally did this.  Lance paid Coyle to testify on Lance's behalf in court as an "expert scientific witness.  It's also possible that Coyle was simply incompetent.

In either case, his paper has been debunked and experts reference it only as an example of incompetence, except in the case of this paper, where Coyle's flawed conclusions are held up as evidence.  

2.  Miguel Indurain
Our Dutch likewise refer to studies on Miguel Indurain as he attempted the hour record.  Based on Indurain's VO2 max, the standard model predicted a distance of 43.645km.  Indurain, miraculously, went 53.040.  The standard model predicts Indurain's VO2max to be almost twice that of the typical pro (10.1 l/m rather than 5-6 l/m) (source).  And yet Indurain, ostensibly an example of how elite athletes are exempt from the benefits of thick blood that acrue to the rest of us, manages to put out power far beyond what he should, given his VO2max and LT.

How does he do this?  Well, the Dutch scholars say, he is exceptional.  An elite athlete.

Indurain has thus far avoided admitting use of EPO, and it's not my place to assert he did (especially when arguing about whether EPO use matters).  

But that's my point--we should use caution when using data taken from elite cyclists tested in the EPO era.  Is it possible, even likely, that Indurain won grand tours and set the hour record while using blood boosting?  Yes.  Is it possible, even likely, that the reason Indurain blows the standard model out of the water, because he was boosting his blood?  Yes.

These athletes put out amazing numbers that belied their VO2max and lactate threshold--are we to assume, as the Dutch authors of this paper do, that doping had nothing to do with this discrepancy?

3.  Emperical evidence

In 2009 I read Ross Tucker's convincing analysis of Contador's climb up Verbier (remember, the one where he dropped everyone and seemed to sprint for about 20 minutes straight up the climb?).




Ross uses fairly conservative numbers to estimate Contador's w/kg at 6.78, the highest rate of ascent ever recorded in a Tour.  In a follow-up post, he then uses Contador's power output and an assumed efficiency of 23% (equivalent to the highest efficiencies ever recorded) to calculate a VO2 max of 98.4 ml/kg/min.

Ross uses the data to suggest something unnatural was going on, a way to beat natural, measurable limiters like VO2max and LT.   In other words, he was suggesting Contador was doped!

VO2 and LT are directly correlated with performance, and efficiency is as well.  And VO2max and LT are also inversely correlated with each other--meaning if one goes up, the other tends to go down.  

Something was going on with Contador, Lance, Riis, and in that era.  We can observe it in the speed, the inconsistent power of individuals over time, and in the power output of riders--output that belied measurement--from that era.  

4.
Dr. Ferrari doesn't go so far as to claim that EPO doesn't confer benefit; he does, however, claim that the effect of altitude is, in terms of benefits, the same.  Is this true?

Some research suggests living high/training low does increase Hg mass.  More recent research (on Australian swimmers) found little to no benefits of altitude training.  In another literature review of available research on altitude training, researchers fail to agree about whether it yields benefits.

Usually athletes living at altitude do see an increase in Hg mass.  However, this increase in red blood cells does not necessarily lead to improvements in performance.

Conclusion
Are the Dutch scientists at least in the right ballpark when the assert that EPO's effect is ambiguous?  Is Lance or Dr. Ferrari right?  Does (or did) one have to dope to win the Tour?  

Some riders, including Jonathan Vaughters, have suggested that they benefited less than others from taking blood boosters.  Vaughters suggested that, because he had a naturally high Hb mass, he benefited less from blood doping than, say, a Lance Armstrong, whose levels are lower.

I believe some of the performances from the Riis/Pantani/Armstrong era were clean.  Probably Boardman and Obree were clean.  Generally, though, the Grand Tour winners were doped.  And the Tour contenders from the mid-90s through 2005 were all, with the exclusion of Sastre, eventually linked with, if not convicted of, one form of blood boosting.


The Dutch review of literature does not throw out the research on elite cyclists from the past twenty years, as should be done.  It's similar to a real estate agent using pricing models from prior to 2008.  That sham is over.  The data is still out there, but it's fairly useless.

Instead of suggesting that research is inconclusive, the researchers should simply have recognized the worthlessness of data collected on elite cyclists since the introduction of EPO.  Instead, they cite that data to show that elite cyclists are somehow exempt from the causes and effects that govern other humans, including the effect that EPO makes you go faster.

The effect of altitude training is ambigious partly because there are costs to living at altitude, just as there are benefits: it increases Hg mass, but it also slows recovery and doesn't allow optimal training.  It's effect, as a whole, is truly ambiguous.

On the other hand, the effect of EPO is not ambiguous for most people:  thicker blood, with some exceptions, leads to more oxygenation of muscles and, usually, better performance.

Dr. Ferrari and the Dutch are full of crap.  Surprisingly, I'll side with Lance on this one.

1 comment:

Steven said...

Great review of the facts. I totally agree that Ferrari is delusional.

I particularly like that Sports Scientist's post. 6.8 w/kg is insane given all the data points we have from the last few years. I hardly think Armstrong could have done that without drugs.