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Commentary: Disputing Ferrari’s altitude training claims, part 2

To illustrate this flaw in Ferrari’s statement, we added a dashed line to represent the level of EPO necessary to trigger a positive test. The purpose is to illustrate that although the “Micro Dose” may result in a “detectable” level of EPO at the time of the anti-doping test it would not necessarily be high enough to trigger a positive result.

This concept proves to be true in Armstrong’s own anti-doping tests. Armstrong produced a sample with detectable levels of EPO at the 2001 Tour of Switzerland after the EPO test had been put in place. While the sample was judged to be “suspect” according to Martial Saugy, the director of the Lausanne laboratory, he also pointed out to the AFP that, “there was no positive test on the Tour of Switzerland in 2001.”

Similarly, according to Saugy, “Armstrong had another suspect result during the 2002 Dauphiné Libéré.” Armstrong’s own results show that the introduction of the EPO test did not stop him from continuing to use detectable doses of EPO, nor did the “detectable” levels of EPO result in positive tests.

Just like he did in the altitude discussion, Ferrari began his doping-related argument with legitimate science. But to fit the “Armstrong could have won clean” narrative, Ferrari stretched the implications of the data well beyond any reasonable conclusion.

Continuing this pattern, Ferrari suggested that from 1999-2005 Armstrong never used doses high enough to produce any benefit beyond a placebo effect. “In fact, the natural production of EPO at sea level is about ‘Sub Micro Dose’ (Klausen 1992): therefore a natural production of EPO of approximately ‘Sub Micro Dose’ keeps Hgb mass constant. As a consequence, there is a no ‘micro-dose’ that is effective on Hgb mass which is not detectable within a period of seven-to-eight hours after administration, also via IV.” Again, Dr Ferrari begins on solid ground but ends up some place far removed from reality.

Armstrong doped, he doped well, and no amount of scientific sleight of hand will change that. During this period, a large number of riders in the peloton used EPO. The doses used were not at all insignificant. Armstrong himself stated that anyone on the podium would fall into this doping group.

In an email, former Armstrong teammate and current Garmin-Sharp boss Jonathan Vaughters was kind enough lay out in detail the doping practices of the time:

For post 50-percent rule, the standard [dose] … gets a guy from 39 percent to 48 percent in four weeks or so and will stabilize it there in a three-week [grand tour].

Now, once the EPO test came into play, initially, the dosage… didn’t change, just the method, from subcutaneous to IV. In a 70kg rider, [this dose] will clear in 24 hours. So, take the shot straight after the stage, it’s out by the time you could get tested the next day.

Once OOC [out-of-competition] testing was introduced and they could come anytime other than between 10:00 p.m. and 7 a.m., a quicker clearance was needed, hence the ‘Micro Dose’ intravenous method.

A quick calculation confirms that the EPO dosing described for the Armstrong era was equal to or greater than the dosing in the Ashenden (2011a) study. Therefore, a 10-percent increase in Hgb mass derived from the Ashenden (2011a) study stands as a safe estimate for the effect of EPO.

In a final attempt to redirect Ferrari in a meaningful debate, I asked directly, “Are you confident that Armstrong never used doses of EPO greater than or equal to ‘Micro Dose’?”

He replied, “I can not exclude it with certainty, but ‘Micro Dose’ is detectable in the urine and blood for more than 10 hours; therefore, I think it unlikely that Armstrong made use of it.”

This statement leaves no room for credibility. When we shared these comments with Vaughters, he responded: “Ferrari is the one who invented the [micro-dose] system!!! … That’s funny.”

Less funny is the depth of cynicism revealed by revisiting Ferrari’s rebuttal in the context of his having developed the micro-dose IV regimen. His argument is built on data contained in #### (1990) figure X, which is now over 20 years old. The age of the data is notable because it precedes the introduction of any test for EPO. The design of the study is also notable because, unlike later studies, which shifted focus to higher subcutaneous doses, it looked at relatively small IV doses. In fact, at the time the EPO test was introduced, this study would have been the go-to article for anyone interested in finding a faster way to get EPO to clear the system. Turning to figure X (#### 1990) would have been like turning to a perfect roadmap to beat the EPO test. Map in hand, designing the micro-dose IV regimen would have been no harder than checking figure X and lifting the IV micro-dose straight from the paper. It’s almost as though his rebuttal above was intended to be an inside joke made at the expense of anyone who didn’t catch his meaning.

Maybe in all of this discussion, the most relevant question asked was not about the science itself, but about Ferrari’s opinion. I put to him whether he had the same opinion, that the altitude was as effective as EPO/blood doping, back in 1999-2005. Unfortunately, this is a question Ferrari declined to answer. Although, in the context of his other replies, maybe his non-answer was about as honest as he could get.

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