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Commentary: Disputing Ferrari’s altitude training claims, part 1

Editor’s note: The following is the first in a two-part series in which sports medicine physician Michael Puchowicz disputes claims made by Dr. Michele Ferrari in January that Lance Armstrong would have seen comparable benefits from altitude training without the use of EPO and other performance enhancing drugs.

The mind that once calculated Marco Pantani’s attacking Mean Ascent Velocity (VAM) without aid, and rightly predicted to “let him hang,” concluded recently that Lance Armstrong’s regimen of EPO and blood doping was no more effective than altitude training.

Michele Ferrari is no stranger to controversial commentary. He famously mused that “EPO is not dangerous, it’s the abuse that is. It’s also dangerous to drink 10 liters of orange juice.” At one time such defiance fueled “The Legend,” his reputation as the greatest performance enhancement doctor in cycling. But on the eve of a truth and reconciliation nearly 30 years in the making, the effect is altogether different. With Ferrari pushing ever further out on to untenable ground, one has to wonder, has he sacrificed his credibility? And if so, why?

The basis of Ferrari’s argument, which appeared on his website in late January, is twofold. First, he proposed that altitude training could produce an increase in hemoglobin (Hgb) mass on the order of five-to-10 percent. Second, he concluded that this change would be an increase equivalent to the one produced by Armstrong’s doping. In support of his argument, Ferrari cited four studies on the effects of altitude (Chapman 1998, Heinicke 2005, Wehrlin 2006, Garvican 2012) and his own opinion on the effects of doping. However, a closer look at the science shows that the data does not support his position.

To illustrate the effect of altitude on Hgb mass, we pooled data pooled from the four studies that Ferrari cited and combined into Figure 1. The Y axis shows the percent increase in Hgb mass from baseline following altitude training. The X axis represents days following the altitude exposure. Day 0 is Hgb mass recorded while still at altitude, and day 1 is the first day back at sea level and so on.

What is immediately apparent from the figure is that only one out of seven data points actually falls into the claimed five-to-10-percent range. Worse yet, the 9.2-percent value, which was recorded while the subjects were still at altitude, came from the smallest study and lacked a control group (Heinicke 2005). For the purposes of a cyclist riding a grand tour, it is hard to see any way that the data suggests the five-to-10-percent increase Ferrari claimed. From these studies, a rider might realistically expect a 2.8-4.5-percent increase in Hbg mass during the first week of a grand tour from a well-timed altitude camp. By mid-tour, the rider would experience a modest bump of 0.8-2.5 percent above baseline, and by the third week, whether any benefit would still be present is unclear from the data.

So, how does a scientist see something so completely different in the same data set?

Did he cherry-pick the best altitude data, minimize the dope effect, and try to paint a sympathetic picture to protect the legacy of a friend?

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