For the sake of thoroughness and closure for the fans of the sport, one final way to address the question at hand is to look as directly as possible at the effect of doping on Armstrong’s blood data. Because only biological passport data from 2008-2009 onward is available, an assumption has to be made that Armstrong’s level of doping in 2009 would have been less than from 1999-2005, though Armstrong maintains he did not cheat during his 2009-2010 comeback.
Similarly, because the bio passport does not contain direct measurements of Hgb mass, increases in Hgb mass have to be inferred from suppressions of the reticulocyte count. With these assumptions made, the data points from June 16, 2009 through the end of the Tour de France stand out.
It is clearly visible here that the reticulocyte count during this period is consistently suppressed, indicating a sustained increase in Hgb mass. In USADA’s reasoned decision, it concluded that “the approximate likelihood of Armstrong’s seven suppressed reticulocyte values during the 2009 and 2010 Tours de France occurring naturally was less than one in a million.” If we rephrased this statement in terms of altitude and doping, it would read: “The approximate likelihood that the effect of Armstrong’s 2009 doping could have been equaled by altitude training is less than one in a million.” So, Armstrong’s own blood data suggests that there was no way that altitude could produce the same magnitude of effect seen with even his 2009 doping, let alone his 1999-2005 doping.
To summarize, a realistic look at the scientific data allows a reasonable estimation that Hgb mass would be increased by 10-18 percent from the combination of EPO and blood transfusions used by Lance Armstrong. Even well-timed altitude training is unlikely to produce a sustained effect greater than five percent. Based on the literature reviewed, Dr. Michele Ferrari’s claim that Armstrong could have won all seven of his Tour de France titles clean is not credible.
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: To calculate the effect of blood doping, we can use Dr. Ferrari’s estimated nine-too-10 liters of blood volume and Armstrong’s average Hgb gm/dL of 14.5. 145 gm/L x 9.5 L = 1377 gm of Hgb. One 0.5L blood bag withdrawn at 14.5 gm/dL would contain 72.5 gm of Hgb. Transfusing a fresh, stored bag with a yield of 72 percent (Ashenden 2011) would increase Hgb mass by 52.2 gm or 3.8 percent per bag.
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