This Month in Journals: Controversy at the Intersection of Doping and Research

Welcome back to This Month in Journals, where we read the latest exercise and sports science and pull out some research that might be of interest to skiers.

Despite being a fairly general journal – other papers this month featured, for example, bone metabolism in lambs grazing in idyllic Alpine pastures – the Journal of Applied Physiology has found itself at the center of a fight over the intersection of doping and research. Rather than hide, the journal decided to tackle the issue head-on.

The criticism focused around two distinct issues. First, the journal had published back in 2005 a paper by Dr. Edward Coyle of the University of Texas assessing the physical maturation of Lance Armstrong from age 21 to age 28. With Armstrong’s recent admission of doping, the paper came under question, as did Coyle; did he know that Armstrong was doping? Should he have been suspicious? Would the journal retract the paper?

Coyle responded in an editorial by saying that, first of all, he had no idea that Armstrong was doping. The original paper’s main conclusion was that the Tour de France champion became leaner and more efficient on the bike over the course of those seven years. Coyle wrote that there was no way to know whether doping affected these conclusions – first because it is not clear what Armstrong used, when, but second because there is no research relating erythropoietin to mechanical efficiency.

Coyle believes that his original conclusions remain valid. He wrote:

“Since publication of the 2005 paper, there have been several reports of champion athletes displaying improved efficiency of movement. The world record holder in the women’s marathon, Paula Radcliffe, displayed a remarkable 15% improvement in running economy between 1992 and 2003.”

(As the blog Retraction Watch, which documents scientific error and fraud in published research, pointed out, it wasn’t the first time the paper was in the news. Coyle had been accused of making errors in his calculations, although the main antagonist was actually a paid consultant for a company in a dispute with Armstrong. Coyle responded in a 2008 interview with the New York Times that “people are drawing their opinions [about the paper] essentially on whether or not they believe Lance cheated… I don’t know what the truth is about that, but I don’t really care.”)

What is a researcher’s obligation with regard to the doping status of his test subjects? This could certainly be a recurring issue for anyone working with elite cyclists – or sprinters, NFL or MLB players, or myriad other athletes.

Journal editor Dr. Peter Wagner of the University of California, San Diego, clearly considered this an unfortunate development, but didn’t think that Coyle had done anything wrong despite the fact that Armstrong may have been doping during the course of the research.

“Should Coyle’s paper therefore be retracted or withdrawn?” he asked in his own editorial. “We do not think so; the data are the data, free of author-related ethical concerns. His editorial seems to be the best solution, especially because there can be no definitive answer.”

Perhaps the reason that Coyle needed to respond was that his study focused on only one athlete. Although he never explicitly named Armstrong in either the original paper or the editorial, his description made it 100% clear who he was working with, so now it is equally clear that the subject of the paper was doping. In papers with larger groups of subjects, it’s impossible for reviewers or readers to connect a later admission of doping to an anonymous participant.

The second battle waged in the pages of the Journal of Applied Physiology looks at the opposite side of the coin: what are the ethics of asking study participants to participate in methods that are banned by WADA?

Last summer, Drs. Christoph Siebenmann and Carsten Lundby of the University of Zurich, along with collaborators, published two papers questioning the efficacy of the “Live High, Train Low” (LHTL) training strategy, one of which was in the Journal of Applied Physiology. At the time, we interviewed U.S. Ski Team doctor Jim Stray-Gundersen, who originally proposed the method, about what was going on.

But this month, the papers came under fire for a different reason, one that had nothing to do with their conclusions. Dr. Yorck Schumacher, a German currently working out of the Aspetar Orthopedic and Sports Medicine Hospital and Qatar, pointed out that in the course of the studies, Siebenmann and Lundby had removed blood and then replaced it.

“Given the sensitivity of the topic, it is surprising that the studies used competitive athletes who likely were license holders of their respective federations and thus bound to Word Anti-Doping Agency (WADA) antidoping regulations,” Schumacher and five co-authors wrote in their letter to the editor. “Under these regulations, both blood removal and reinfusion and using plasma volume expanders are forbidden. Therefore, the athletes who volunteered to participate are in conflict with antidoping rules.”

It may be the case of a turf war or sour grapes: Schumacher has also researched LHTL.

The journal have Siebenmann and Lundby the chance to respond, and the authors pointed out that they had mad test subjects aware of their potential violation of WADA rules and also cleared the study with the national antidoping authorities in France and Switzerland, where the research was performed. They believed they had behaved ethically.

The point of the blood draws and then retransfutions was to examine adaptation to hypoxia. At the end of the 4-week block of either LHTL or placebo lifestyle, the researchers had tested performance on a stationary bike. Then, just after the first test, they had either removed blood and/or injected a starch solution to return the study participants’ blood volume and dilution to its pre-study status, and tested them again. The goal was to see whether any adaptation was merely a product of increased volume, or something more specific in the blood.

Furthermore, they pointed out, the blood was drawn and re-transfused all in the course of a single day.

“The second maximal test was initiated 2 h after the end of the first bout of exercise,” the authors wrote in the original British Journal of Sports Medicine paper. “After completion of the second exercise test, the subjects were either reinfused with their own blood, or infused with saline, again by using a blinded design.”

Removing blood and retransfusing it is a violation of WADA rules, which both the researchers and the athletes were aware of. But the result was not performance-enhancing, Lundby and Siebenmann wrote.

“Less than 30 min after completion of the second exercise test, any red blood cells removed before the second VO2max test were retransfused,” they explained in their letter of reply. “Thus it should be clear that the study participants experienced absolutely no athletic gain by participating in this specific part of our study.”

Furthermore, they pointed out, this was an unusual case of the pot calling the kettle black. Schumacher, a blood-doping expert, and several other authors on the letter to the editor have performed their own research which confronts the same ethical issues – perhaps even more strongly. One study, for instance, gave a “doped” group of athletes recombinant erythropoietin three times a week for eight weeks. Another gave a group of cyclists autologous blood transfusions for 42 weeks, simulating a competitive season. (While morally debatable, these studies were certainly valuable in adding to both our understanding of physiology and to anti-doping efforts.)

Not content to simply let it rest that their own journal had probably not made any grave ethical violations, the editors also reached out to WADA and published the anti-doping organization’s response to both this specific case and the use of banned methods in research more generally.

WADA Director General David Howman made it clear in his reply that as far as WADA was concerned, the athletes in the LHTL study had broken the rules. The fact that they were described as national- or international-level competitors meant that the WADA guidelines did apply to them, that they could be tested, and that their behavior was sanctionable.

In WADA’s own research, Howman said, scientists work only with “occasional or recreational athletes to circumvent the risk of exposing elite athletes to prohibited drugs or methods” and also allow a long “wash-out period” to minimize effects of these methods. Other scientists, he implied, should do the same.

He has a point, obviously. But at the same time, recreational athletes and highly-trained elite competitors don’t necessarily react in the same way to an illicit substance or method. To develop tests or simply determine whether something is performance-enhancing, it may every once in a while be greatly beneficial to use subjects who are physiologically similar to those who face WADA’s randomized or in-competition testing.

If researchers want to do this, how can they? Lundby and Siebenmann point out in their letter that in some countries, national federations ban the use of altitude rooms, which are essential to a whole field of exercise science. Navigating the maze of local and international rules is not easy. They had followed local guidelines and, they felt, the spirit of the WADA rules, if not the letters of the law.

The journal’s editor, Wagner, hoped that by publishing WADA’s position on this type of research, it would be more clear to researchers what their ethical obligations were, and that they need to inform test participants that they may run afoul of WADA.

“Although the Journal considers that banned substances/procedures research in elite athletes is as legitimate a scientific area as any other, investigators will need to be very careful before exposing their elite athlete subjects to risks of sanction by their governing bodies,” he wrote. “What are our editorial responsibilities then in circumstances like this? They are: to provide a forum for open discussion; to ensure there are no ethical transgressions in any articles published; and to inform our readers of the issues, including the positions of relevant authorities (here, WADA), to help prevent future, similar situations.”

This Month in Journals is our occasional series surveying the world of sports science and trying to extract tidbits of research that might be of interest to the skiing public. Previous editions can be found here: April, March, February, January, December, October, and September.