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Wednesday, February 15, 2012

Doping in cycling: Science, the law, and PR, and insights on Pistorius

The complexity of science vs law vs PR: Implications for anti-doping and Oscar Pistorius

I've finally emerged from the "bubbles" that were the trip up Kilimanjaro, which was followed almost immediately by a trip to the USA where I spent a week with the SA Sevens team for the IRB Series tournament in Las Vegas.  It was another harsh reminder that the best preparation and hardest work can sometimes fail because on the day, things don't work and other teams are better...competitive sports is a ruthless world!

In any event, those tournament weeks are always something of a "bubble", inside which I miss many interesting sports stories.  The jet lag and 9 hour time difference don't help, but the bubble has finally burst and I thought I'd share one or two links, and some short insights on stories that have broken since late January.

Cycling and doping: Three big stories

To begin with, three big stories in the world of cycling and doping.  In no particular time order, Jan Ullrich, Tour de France champion and many time runner-up was sanctioned by the Court of Arbitration for Sport, and all his results since 2005 annulled.  He of course retired years ago, so the two year ban is more symbolic than practical, but it ends one of cycling's more high-profile chapters.  Ullrich, for his part, responded on his website, apologizing for his dealings with Fuentes, but not entirely accepting the court's opinion.  You can read his full statement here.

This decision was preceded by perhaps an even more significant one - the US Attorney Andre Birotte Jr announced that the federal investigation into Lance Armstrong would be ending.  The announcement was strategically timed to garner as little media coverage (in the USA) as possible, coming the Friday before the Superbowl.  There has however been some reaction to it, mostly dealing with the timing of the decision (the investigation had been a 2-year long struggle up to this point), and perhaps more importantly, the legal vs ethical issues surrounding doping.

Those who have kept up with the case will be well aware that doping in sport is not a federal crime.  As a result, the investigation was not about whether Armstrong doped or not, it was built predominantly around fraud, conspiracy and other charges related to the violation of Armstrong's team's contract with the U.S. Postal Service.  Those who are proclaiming "innocence" are thus choosing to stop short of the point, at least as far as doping goes.

The result of this is that the federal investigation may have been dropped because of a simple balance between "cost" (time and financial) and "reward".  There has been no explanation for why the investigation has been dropped, and nor is there likely to be, leaving most to speculate and wonder what the reasons are.  One of the outcomes is that the ball is now firmly in the court of the anti-doping authorities, such as USADA, who can continue to pursue the case of doping against Armstrong.

There were reports, since confirmed, that USADA had been in contact with the investigators to gain access to the evidence they had collected as part of the criminal case.  Travis Tygart, the CEO of USADA, issued this statement following the US Attorney General's annoucement:

"Unlike the U.S. Attorney, USADA's job is to protect clean sport rather than enforce specific criminal laws. Our investigation into doping in the sport of cycling is continuing and we look forward to obtaining the information developed during the federal investigation."

Time will tell whether that evidence is forthcoming, and how it is acted upon, but certainly, the announcement that the investigation was ending is not the same thing as drawing a line under the issue.

Sports Illustrated yesterday carried this article expanding on the USADA investigation, for those interested in reading more.

The Contador verdict

Then third, and most relevant to cycling today (since he is the only active cyclist of the three), was the decision, finally, of CAS on the Alberto Contador case.  The end result of over two years of deliberations and court proceedings, protestations, accusations and cow slandering?  Four thousand pages of argument and counter-argument, a 98-page verdict, and a two year ban for Contador, which is really only 6 months, because it has been backdated to when the case began.

There are far better summaries of this case than I can provide in a short time.  For perhaps the best, read Matt Rendell's excellent analysis here.  He tackles issues of strict liability, the Contador defence (veal solomillo and clenbuterol, at 32 Euros a kilogram, apparently), and the UCI/WADA argument, which was built around the likelihood that the clenbuterol came from the infusion of plasma as part of Contador's alleged blood doping during that Tour de France.

This defence is particularly intriguing to me, because it has evidence supporting it, and therefore can be "proved" (in so far as "proof" seems to exist in these cases).  That evidence was described by Prof Michael Ashenden, one of the leading biological passport scientists.  He reported to CAS that Contador's reticulocyte percentages during the race were abnormally high, which would be indicative of EPO use, because that switches on red blood cell formation (for more on the biological passport, reticulocytes and how all this works, read this article that I wrote last year).  Contador's hemoglobin levels were also abnormal, compared to his biological passport history, leading the UCI, WADA and Ashenden to suggest that they were consistent with blood doping.

Ultimately, the CAS tribunal ruled that a blood transfusion was "very unlikely to have occurred", though I'm not sure why they came to this strong decision.  It was perhaps related to the biological passport's own internal requirements for a "strike", which I explained previously.  It was Ashenden's testimony, the legal back-and-forth it caused, its ultimate dismissal and then the CAS judges refusal to allow Ashenden to have a final session of questioning that was leaked to the press after the hearing, so unhappy were the WADA/UCI lawyers.

The legal battle - how law undermines the openness of science

All of which brings me to my main opinion/insight on these matters.  The fact of the matter is, as anti-doping becomes more sophisticated, it becomes more and fraught with the burden of scientific "proof". The reality is that science is open, it asks questions and only answers some of them!  It is rarely black or white, and the problem with this is that legal teams, armed with scientific experts of their own, can always, without fail, cast doubt on scientific findings.

To me, the findings of abnormal reticulocytes and hemoglobin concentration points very strongly to a likelihood of transfusion.  It doesn't prove it - the biological passport cannot prove anything in that way, and it has been designed like this to protect cyclists against false positive tests.  However, it points there, and so when a tribunal, dealing with the same evidence I'm seeing, concludes that a transfusion is "very unlikely to have occurred", I'm left mystified at their thought-processes.  At worst, they can conclude that a "transfusion is possible, but cannot be upheld given the physiological complexity of blood parameters".  But to dismiss it as "very unlikely"...?

A declaration like that ("very unlikely to have occurred") is definitive, it is black and white.  Science is grey, and so the two, science and law, seem to be very uneasy bedfellows.

Science being picked off, one by one, by the law

I have long held this opinion.  It began as a healthy skepticism of lawyers, and it was the Oscar Pistorius-CAS decision that pretty much condemned me to have zero confidence in the manner in which the law evaluates scientific evidence.  That decision was, to be blunt, a complete joke, and the CAS was manipulated by Hugh Herr and the rest of the Pistorius team, because they were able to exploit scientific "uncertainty" to win a legal verdict.

Then yesterday I read this absolutely brilliant piece by Lionel Birnie, in which he explains how the law attacks science and undermines it exactly because it is open.  As I was reading it, I found myself thinking "This piece could just as well have been written for the Pistorius case".  Science's greatest strength is its weakest point in anti-doping cases (and in cases like those of Pistorius).  Here is a section of Birnie's piece, which I highly recommend:
It seems that a lot of people love to put their faith in the law and yet are sceptical about science. The law is man-made (and therefore flawless) whereas what we know about science keeps changing (and therefore cannot be trusted). This applies to sport just as it does to many areas of life.
Science is attacked for its greatest strength – the fact that it cannot prove or disprove everything. Science is exploratory. It is open-minded and willing to accept that there may be another possibility, however slim the idea may seem. Science is never so arrogant as to presume it knows everything. 
When dealing with anti-doping cases, the law is exploitative in the sense that it seeks out areas where science is on shaky ground. It looks for loopholes and unpicks them ruthlessly. You could argue that science sees the dots and tries to work out how they are connected, while the law picks them off one by one. 
We have seen in many anti-doping cases how the defence lawyers work through the argument line by line, clause by clause, trying to prove or disprove.  And that is why we end up with such division among sports fans who are struggling to work out who the good guys are and who are the baddies.
So many jewels in that piece alone - "Science is open-minded and willing to accept that there may be another possibility", and "science cannot prove or disprove EVERYTHING".  Case in point - dehydration and performance.  There are scientists who maintain that any dehydration will compromise your performance.  There are others who argue that we can lose 2 to 8% of our fluid with no negative effects, and they cannot reconcile those two opinions, as simple a question as this may appear.  Science is full of areas of contention, and doping is perhaps one of the most complex.  The case of Pistorius is equally complex - the evidence certainly pointed to an advantage, but clever scientists, backed by even smarter lawyers, are able to "pick them off one by one".

Direction dependent - the verdict depends on who gets the final scientific "disproving" say

Therefore, what we had with Pistorius was a case of science trying to "join the dots" and create a picture that he had an advantage, while others picked off those points to cast doubt on this finding.  The key is to realize that this could have happened in either direction.  That is, it could have been designed in a way that said that Pistorius was clear to compete unless the IAAF could show that an advantage existed.  Then, the IAAF would have had the initiative and would have been able to cast doubt on evidence suggesting there was no advantage.  As it was, the question was asked in the other direction - the starting point was that Pistorius had an advantage, and this could be disproved (legally) by picking off the evidence.

Therefore, the decision you arrive at depends entirely on the direction from which you approach it, at least in terms of how the science is evaluated.  In anti-doping, this start point is determined by the concept of "strict liability" - the athlete has to show that the positive test was not the result of doping.  For Pistorius, the burden was with the IAAF to prove that the advantage existed, and so Pistorius' team were able to deflect every scientific finding with enough doubt to get the verdict, despite the scientific evidence (which didn't meet CAS' legal standard, clearly, though there were other factors in play here too)

Enter public relations

Lionel Birnie's great insight didn't end there, however.  He also recognized that it is a third party, Public Relations, that ultimately wields the biggest stick in cases like these.  He writes:

The court of public opinion is where the phoney war is fought. Over the past 18 months, while science and the law have been carefully preparing their arguments for serious scrutiny, the public are teased along as if they’re watching a Punch and Judy show.
PR is flashy. It comes up with catchy phrases that capture the public imagination and it wins hearts and closes off minds.  It is hardly surprising that most people will be turned off by the idea of wading through pages of legal and scientific argument. It is difficult, it strays well outside our areas of understanding and it makes our brains hurt.
Once again, this is so accurate for the Contador case, it's accurate for Armstrong, it's accurate for Pistorius (thanks Nike and about a dozen other sponsors).  Last year, Prof Peter Weyand, one of the researchers who did join the dots to see the advantage Pistorius had, wrote to me after I published his explanation of his research, and expressed frustration at how the general public do not want to wade through the complexities of the scientific argument.

He is 100% correct.  I share this frustration, and when I read drivel like the recent Outside magazine or New York Times pieces on Pistorius, it's tremendously frustrating because one half of the scientific team (Herr) are making idiotic claims that have no basis in evidence or reality, while the other half (Weyand) are being circumspect and scientifically cautious.  Public relations looks at this with glee, because it's so easy to back the extreme view, however false or inaccurate it may be.  That fuels the fire, and the public are watching, to borrow Birnie's phrase, "a Punch and Judy show".

The general public, and therefore the general media who cater to them, do not want to peel back layer after layer of scientific explanation to truly understand a case.  They want simple answers, black and white, and science is incapable of providing them.  PR, on the other hand, thrives on simple answers.  Backed by legal complexities, it's not difficult to see why so many people are confused, and therefore choose to hear one message over another without necessarily understanding it.

The fight against doping - the danger of crippling complexity

So, for doping, there is a real problem.  Anti-doping is becoming so complex that it may end up crippling itself in the court of law.  The more dots there are to join (the role of science), the more points there are to attack (the role of law).  The end result is that the cost of prosecution will sky-rocket, it will become increasingly difficult to enforce test results, and the public, ultimately the "paying" customer, will be turned off by the complexity.  Enter the PR firms.

There is an anti-doping future, then, which exists on the internet and is waged by PR firms and athletes, who build mountains for anti-doping authorities to climb.  All of this is a call to action, though it beats me what the solution might be.

The end result for Contador is that he'll be able to race in the Vuelta this year.  We still don't know if he did anything wrong - having dismissed the Contador argument of contaminated beef, having dismissed the UCI/WADA argument of a blood transfusion, the CAS tribunal ends up concluding that a "contaminated supplement" is more likely the source, and therefore grounds for a ban (read part 2 of Rendell's excellent analysis for more on this).

Contador's results have been annulled, and so Andy Schleck is your Tour de France champion from 2010 (a hollow victory).  It could have been worse, of course - I was actually surprised that CAS did reach the decision it did, I fully expected Contador to be cleared, and so perhaps there is some hope left.  Whether such a long, and expensive process, changes the anti-doping game in the future remains to be seen.  Your thoughts welcome, and I realize that there is so much to the verdict and the argument that I haven't covered, but I highly recommend Rendell's pieces, both Part 1 and Part 2 on the judgment.

 The "upside down" VO2max protocol

The other interesting story, one that has garnered some great discussion on our Twitter account, is the recent study that found that VO2max is increased when you do a reverse protocol that starts out at a high power output and decreases (as opposed to the normal progressive increase to fatigue).  The implication of this finding is that the VO2 "max" concept is incorrect, which is something many already knew, but it calls into question the idea that oxygen delivery or use is limiting during maximal exercise. After all, if VO2max can be increased and then maintained simply by doing something different, despite maximal effort, then how was it the limitation in the first place?  The implication of your answer to this question is rather important!

The study is therefore a hook for the idea that something else regulates performance, though it doesn't establish precisely what that is.  There is the suggestion that the brain is in control, and that's so obvious many people will dismiss it as "too easy".  But there are many reasons to suggest this, and I'll cover these in a blog post as soon as I can.  The bottom line, regarding this study at least, is that it's fairly obvious, and not as outrageous as it may seem.  But the reaction of people who see it tells the story of sports science and the VO2max theory, which has long been full of holes, but remains entrenched among many as the explanation for maximal performance.  This is akin to proclaiming that the world is flat.  Someone has to point out that it is round, and as obvious as this may be (the idea that the brain is command is equally obvious), this study adds to that realization.

Perhaps even more important are the implications of this.  People make the incorrect leap that it's about "mind over matter". The idea that the brain controls exercise is not the same as saying that our mental capacities determine performance.  This is obvious.  It's not "mind" over matter, but "brain" over matter - it's still physiology, so let's not get too carried away with the idea that we can "believe" ourselves into being elite athletes.  Certainly, psychology is crucial, and belief is essential, but the physiological limits still exist, and the regulation of performance is still physiological!  Can we do more with the right mental approach?  Of course, but that's a parallel area of performance management.

More to come...


Wednesday, February 01, 2012

Barefoot Kilimanjaro: Mission Accomplished - Video diaries

Barefoot Kilimanjaro: Mission Accomplished - The Video Diary

On Saturday, 29 January, at 12.45 South Africa time, our entire team of six barefoot climbers (that's me on the right - pics of the whole team coming soon!), and four support crew (in shoes) reached Uhuru Peak, at 5,895m, the summit of Mt Kilimanjaro and the highest point in Africa.

The trip, as I explained recently in my "pre-expedition" post, was both for the challenge and for charity.  There will no doubt be much more said in the coming days - I will post a series of pictures and talk you through my own personal experience with my feet as soon as I can - but for now, we are all proud of achieving it and very grateful and thankful for all the great support we have received.

"Crazy with a capital C"

Before leaving, I wrote a post and tweeted to say we were on the way with the goal of reaching the summit entirely barefoot.  What was striking to me was the number of disbelieving replies that came in soon after.  They ranged from "hahaha - that's ridiculous", to "I hope you're kidding", to "Crazy with a capital C", and perhaps most intriguingly, someone who felt that it was "disrespectful to the mountain" to attempt to walk barefoot.

My take was different - back in November, when I was first asked "Is it possible?", the obvious answer was "yes".  I remember saying at the time that it needed a lot of research, and possibly some creative solutions and planning, but of course it was possible.

It would be wrong to say "anything is possible", because that's the stuff of fairytales, but this was so clearly possible IF we played the preparation cards right, that it was a project worth doing only to show that sometimes, when we stop at identifying the problems, we limit ourselves so significantly to "conventional wisdom".  I was taken aback by the strength of the sentiment AGAINST our goal.  I mean, sure, there would be challenges - the cold, the risk of frost-bite, the altitude, the terrain - but those are challenges that can easily be overcome through good planning, and I couldn't understand that it was dismissed as "impossible" without thinking through those solutions first.

We as a team make no claims about this, physiologically or otherwise.  You'll see a lot of hype around people who do "unusual" things.  Firstly, I don't believe we did anything "unusual", at least from a physiological point of view - it's perfectly explainable, the difference is that it goes against conventional ideas.  But ultimately, we were five very normal guys and one girl who did something that was eminently possible all along.  The fact that it was THOUGHT to be crazy, ridiculous (pick your synonym) is merit-worthy, but it's not a physiological feat that demands anything other than acknowledgement of what is possible.  No "awe" or "wonder" here, just basic planning and principles.  Challenge beliefs - it's amazing what becomes possible!

I realise that walking up a mountain barefoot is "odd".  But if I may speak personally, apart from the great charity that it supported, the most appealing thing to me was to show up conventional wisdom by doing with 100% success rate.  I was not alone - many of the team were motivated by the 'nay-sayers' and I can honestly say that when all six of us got to the summit, with no drama, there was a feeling of vindication mixed with the happiness.  All it took was planning and preparation with intelligence, foresight and discipline. 

Clinical and "easy" thanks to the 80% done BEFORE

Ultimately, to be perfectly honest, we were clinical, precise and got to the summit relatively easily.  I'd go so far as to say that probably 80% of expeditions to Kilimanjaro have MORE problems and issues than we had, despite being entirely shod.  Perhaps being barefoot forced on us a more stringent approach, but it worked, and that should, I would hope, shake a paradigm or two.

It's never "easy" of course, and I don't wish to downplay the whole effort.  But the 80-20 principle is in play - I believe that the success of any "performance" is determined 80% BEFORE the performance ever happens.  It is the result of the months of preparation and training, and the actual achievement is only 20% of the challenge.  The team on this trip was super strong - 5 months of barefoot training, including a month of cold-weather preparation, plus real discipline about the altitude, meant that by the time we took our first steps in the Rongai Rain Forest, we had done pretty much all we could to prepare.  The remaining 20% was about adapting, learning on the go, and making sure we stuck to the plan.

We had the best support possible - Sean Disney of Adventure Dynamics International was, in my opinion, THE key player in the team, and he planned the route, controlled our pace, and guided us expertly throughout the five days to summit.  If you're interested in this climb (or others around the world), that would be my first port of call, and it obeys the # 1 principle - get the best people on board.

My personal account - bad timing complicated the climb, but still doable

Speaking personally, I made life difficult for myself by getting frostbite on Friday 13 January (I'll always remember the date!).  My timing, in hindsight, could not have been worse.  The frozen areas of skin formed blisters, and the blisters decided that they would start peeling on January 23rd, which was the very first day of the hike.  So as I climbed in altitude, my feet lost more and more skin, and by the end of day 3, in Mawenzi Tarn, I had no skin left underneath (the pic on the right is from the Tarn - the color is because I threw Friar's Balsam at it to try to dry out the soft, raw skin.  I don't think it really helped, but just doing something helped me in other ways!  I'll show you a pic of what my feet looked like at the summit in tomorrow's post!)

So I lay in my tent that afternoon, January 26th, full of anxiety, not thinking I had it in me to do another two days to reach the summit.  But I decided to go hour by hour, for even one more day.  Get to Kibo Huts, the final base before the strike for the summit, and see whether that would be the motivation and source of one big, final effort for the summit.   That worked, and then it was summit day, and another "hour by hour" exercise, all the way to the top.  In the end, it worked, and yes, it was difficult, but the pictures made it look worse than it was, and had it not been for the frost-bite and blisters it caused, I think it would have been a relatively clinical and "easy" week for me too.

I'll explain a little more of what I felt during those last two days when I show you some pictures, and that will perhaps come tomorrow.

But for now, here are some videos - I tried to do a daily video diary.  They're fairly short, only a minute or two, but they show where we are on the mountain, how the ground looks, what we're doing day by day and how I'm progressing.  If there are any questions, I'm happy to answer them in the comments, and as I said, I'll do a picture diary tomorrow, with more detail about the feelings and emotions as I dealt with my own little issues on the final two days!

NOTE:  To all readers receiving this in email - the YouTube clips may appear as solid, black blocks in your emails.  Please CLICK HERE to be taken to the site to watch videos.

Day 1: Rongai Rain Forest - a relatively sedate start

Day 2: The longest day

This was a super long day - 8 hours 51 in total, but with a long break for lunch.  Also a challenging day, the gravel and rocks were difficult and was probably largely to blame for the loss of skin in my case!  But it was a good day, an optimistic day because it showed us what we were in for - we got a taste of the terrain, the temperature and altitude.  Probably just what we needed.

Day 3: Mawenzi Tarn

A short day, but a key day for me personally.  By the end of this day, my skin was largely off and I had doubts about making it to the summit.  The team coped brilliantly though, and so this was the day I grew 95% confident that we would get 5 people, at least, to the summit.  The other great thing about this day is that I was finally convinced that the cold would NOT be a factor in our summit - the African sun was just too strong and would prove decisive in minimizing the frostbite risk.  That became crystal clear today.

Day 4: To base camp at Kibo Huts

Perhaps the toughest day for me, mentally, because it took us 5 hours from Mawenzi to Kibo, where we'd be based for our "strike" to the summit.  For me, this was tough because it was not the final big effort, but it was difficult enough to be a real challenge.  Difficult terrain and a relatively long day.  The team again handled it well, and if I was 95% confident yesterday, I was 98% confident today.

Day 5: The summit 

This is a really short video of us arriving at the summit.  Interestingly enough, this was not the greatest moment of the trip.  In fact, the summit was actually a little bit of an anticlimax for me, because my "peak" had happened about 45 minutes early, at Stella Point.  That was the moment when I KNEW, with 100% certainty and beyond any doubt, that all six of us would make it.  It was a huge release, and that was the single best moment for me. The summit was still amazing though, don't get me wrong!  Big celebration!

Day 5: Descending

This video didn't quite work out - the day before, we'd checked out the climb and run down a section of the steep slope (it's about 40%).  It's a real rush - you slide with every step, and churn up shale and dust big time.  I tried to do it on the way back to Kibo, but by this stage (almost 9 hours of walking, most of it above 5,000m), I was pretty stuffed!  And the lack of perspective from the way I filmed it doesn't do justice to the speed of the descent, so it didn't quite come off!  It was still really fun to do though!

Day 5: In the tent

I nearly didn't put this video up - I filmed it only minutes after getting back to base camp.  I was tired, a little cold, and quite drained.  I didn't realize quite how tired until I watched myself - I look and sound shattered!  But it's from the moments after the mission had been accomplished, just some thoughts!  A longer clip, but with the key message, so bear with me!

Picture diary to come

That's all for now - I'm working through all my pictures, and I'll get a nice story out of that, mostly where I can talk you through the challenges of terrain, cold and altitude, and how we progressed.  It also tells the story of my feet quite nicely, but that's for another time!

In the meantime, for more thoughts from the other team members, and very importantly, to make donations to the Red Cross Children's Hospital Trust (a great cause), please visit the official site of the barefoot Kilimanjaro trip!

Chat soon