Lacking further input from Ferrari, consider the strongest Hgb mass data that is available, shown in Figure 6.
First, these studies used three-week altitude exposures, which are greater than the two-week blocks proposed by Ferrari. Therefore, the data points would need to be adjusted downward accordingly. Next, from the controlled studies with multiple time points, the data suggests that Hgb mass falls fairly rapidly after altitude exposure is stopped. If this same rate of fall occurred after a two-week exposure, it would be unlikely that there would be much remaining elevation in Hgb mass before starting the next two-week altitude exposure.
As a whole, the data suggests that altitude exposure, whether from a continuous three-week block or from accumulation from repeated two-week blocks, would not result in a five-to-10-percent increase in Hgb mass at a time point relevant to a grand tour. Without any of Armstrong’s personal data to suggest otherwise, Ferrari’s altitude claim is not credible.
Part 2 of this analysis will look at the effect of EPO and blood doping on Hgb mass with further discussion from Dr. Ferrari.
Michael Puchowicz is a former lab rat turned sports medicine physician. After the last two years of laying waste to grammar, farce, and pretense in the shadowy world of anonymous cycling blogs and Twitter rants, he’s finally caved and gone legit. Please don’t mistake his views for those of his employer, his friends, or anyone else linked by real or perceived affiliations through the medical and science communities. To do so, would surely end his uncompromising pursuit of all things true and glorious in cycling.
Author’s note: I do thank Dr. Ferrari for engaging in this discussion. I very strongly disagree with the actions for which he is banned from cycling, but I wish him no ill will as a person. There is some concern that engaging Ferrari gives him a chance to pivot away from his own culpability and distracts from more important efforts to clean up the sport. I agree with this concern. However, the questions being addressed have defined cycling for too long for the sport to be able to move on without closure.
In the Hgb mass figures, data from studies with a control group was plotted as the percentage above baseline compared to the control group. Data from studies without control groups was plotted as the percentage above baseline. Data was extracted from graphs when the numerical value was not available. All reasonable effort was made to not introduce additional error.
The Chapman 1998 study was designed to look at the differences in physiological parameters between “responders” and “non-responders.” In order to make this data set usable for the analysis of the effect of altitude, the two groups were pooled together and the average change from baseline for all subjects was used.
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