Performance Optimal: Can micro-dosing really improve performance?

In a continuing series of articles and podcast as we lead up to the World Cycling Championships in September, I delve into doping through micro-dosing. As testing has became more stringent in the 2000’s, it is believed that athletes, including pro cyclists, moved to micro-dosing drugs like EPO to reap smaller, but undetectable benefits. In it’s report on Lance Armstrong, USADA indicated that this became the method of choice in conjunction with transfusions. More recently, France 2’s sports magazine show Stade 2 allegeable “proved” how effective micro-dosing can be by conducting an unauthorized and uncontrolled study of their own; I won’t bother discussing how unethical it is to conduct such a research study is. While their results appear impressive, when we delve into their tiny study and take into account the placebo effect, micro-dosing may be far less effective than it seems.

Research: Tabloid Journalism Style

Eight athletes (runners I presume) were given small doses of EPO and retested after 1 month with the following results:

  • 6.1% improvement in VO2 max
  • 2.1% improvement in 14km static bike time trial
  • 2.8% improvement in 3,000-metres run

Let me just state unequivocally how shitty this study was; almost as bad as most of the garbage research GCN puts out. First, the only reason I can think of for doing a bike and run test is that they had both runners and cyclists in the study who did one or the other test; i.e., their sample size is so minuscule as to be useless for drawing any type of conclusions. Second, we have no idea what the initial fitness level was of this athletes, what training they were doing before, or what they did during the month of the study; depending on initial fitness level a 6% improvement is not a lot. To that last point, was the improvement in VO2 max in absolute terms or relative to body weight? If its the latter, then we have to ask if they lost weight. Regarding the time trial improvements, we have no idea what the variability in response was. The fact that they reported averages and not median values show that they either do not understand even basic statistics, or they were more interested in creating media hype. Finally, even without the problems of a small sample, they have no control group to compare their subjects to. If they did, then we would be able to know, assuming the controls were similar and performed the same training, that it was the drug that helped and not confounding factors like training or a placebo effect.

What’s in a Placebo Effect?

Most of us have at least a general idea of what the placebo effect is, but many people often dismiss it, or worse, embrace it. I’ve lost count on how many times I’ve heard someone say something to the effect, “What’s the harm of a placebo effect if it makes you better?” Outside of the fact that we simply never learn if something really works, a placebo effect can lead to at best wasted resources (i.e., you buy a product that you do not really need), and at worst, precludes individuals from using treatments that really work that might save their lives; Steve Jobs learned this one the hard way. However, specific to micro-dosing in elite athletes, it is entirely possible that all we’re seeing is a placebo effect. How can I say this? I cannot, but research can.

In a paper just published by Ross et al. in Medicine and Science in Sports and Exercise, 15 club level runners completed a randomized cross-over study where runners injected either OxyRBX (actually saline), a drug they believed was performance enhancing, or nothing for a 7-day period before being retested. As a cross-over study, all runners had both treatments. The findings were nothing short of intriguing. Compared to control, the injected placebo improved 3-km race time by 1.2%; both statistically significant and relevant to real-world performance. The runners also reported reduced effort level, and greater motivation. If 1.2% seems irrelevant, consider that the difference between Chris Froome and Thibault Pinot final overall time at the 2015 Tour de France was less than 1%; incidentally, the difference between 1st and last place was just 5.8%.

What to Believe

It seems that no matter how far the testing evolves, cycling fans seem unable to move beyond doubt. These doubts are only fueled by armchair analysts, federation officials more concerned with image than truth, media outlets looking for ratings, and of course the regular positive drug test. For me, however, I still enjoy watching the sport for what it is, and try not to get bogged down in the innuendo. The fact is, I can, and have, made the case for why riders are or are not still doping, because if you look hard enough you can find the data you seek. However, if you ask my honest opinion, cycling is not any worse than other sports and is still cleaner than it ever has been. And, I saw nothing at this year’s Tour to suggest otherworld performances like Miguel Indurain’s utter decimation of the field in the 1992 TdF’s first time trial more than 20 years ago!

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