One of the quirks of following pro cycling is a passing knowledge of medical vocabulary. Words like quadriceps or lactic acid are obvious. But worryingly the discerning fan can build up a formidable lexicon of haematology, although knowing the vocabulary is quite distinct from knowing the subject. In recent years the likes of haematocrit, reticulocyte and plasma have appeared in cycling headlines. Now the latest concept is “blood irradiation” following allegations in Germany. Here’s a small explainer.
First, a little disclaimer: what follows is what I’ve managed to learn, like many topics on here I try to explore an issue and put some of the ideas here. So if you know better, please share via the comments or email.
As background there’s a Skandal in Germany over the apparent practices of Doktor Andreas Franke but he denies the charges. Cyclingnews.com tells the story and explains what is involved:
The treatments are said to have involved removing blood from the athletes, treating it with black light, and re-infusing it.
This technique is known as “blood irradiation” and as suggested, blood is removed and then exposed to “black light”, which is another word for ultra-violet light.
Normally exposure to UV kills off bacteria but this depends on the intensity of the light. Hospitals can use UV to sterilise. Swimming pools and aquariums can pump water past UV light to clean the water and it is used for drinking water too. The difference with these systems is they rely on pumping all the water past the UV light whereas the “therapy” in question here seems to involve taking a small amount of blood out and subjecting it to UV, leaving most of the blood untreated.
This practice seems questionable, here is Wikipedia on the subject:
Ultraviolet blood irradiation may also be applied, though it involves drawing blood out through a vein and irradiating it outside of the body. Though promoted as a treatment for cancer, a 1952 review in the Journal of the American Medical Association and another review by the American Cancer Society in 1970 concluded the treatment was ineffective. Stephen Barrett, writing for Quackwatch, lists ultraviolet blood irradiation therapy as a questionable treatment.
Of course Wikipedia is not authoritative. Several websites quote a paper from Virgil Hancock from the 1940s who claimed the following benefits:
- Inactivation of toxins.
- Destruction and inhibition of growth of bacteria.
- Increase in the oxygen combining power of the blood and oxygen transportation to organs.
- Activation of steroid hormones.
- Vasodilatation.
- Activation of white blood cells.
- Decreased platelet aggregation
- Stimulation of fibrinolysis (the breakdown of blood clots)
- Decreased viscosity of blood
- Stimulation of corticosteroid production
- Improved microcirculation
For a doctor looking to enhance athletic performance, this sounds very useful. But other reports suggest the oxygenation boost is short-lived, patients get a red flush after therapy but this wears off within an hour. Indeed Hancock’s work seems to be quoted only on poorly designed websites, by a few quack “doctors” and some seeking to sell certain therapies. It might well work… but it doesn’t seem mainstream to put it politely.
But is it doping?
This is the big question facing Dr Franke and possibly the athletes on his patient list. The removal of blood for therapeutic reasons is allowed today, for example the practice of blood spinning is tolerated because it involves platelets and not “whole blood”.
In part the response is a question of time. The allegations made against Marcel Kittel concern 2008 and back then the WADA Code was looser. “Artificially enhancing the uptake, transport or delivery of oxygen” was banned as was “blood doping” but if done for therapeutic reasons then the practices of Dr Franke probably, possibly were tolerable under the rules at the time, even if there’s little evidence to point to benefits.
Today the “sequential withdrawal, manipulation and reintroduction of any quantity of whole blood into the circulatory system” is forbidden by WADA meaning blood cannot be taken out and put back in, whether for therapy or doping.
Indeed this evening Project 1t4i have put out a supportive statement saying Kittel and team mate Patrick Gretsch underwent this treatment in the past but they do not believe it to be related to doping. Indeed Kittel and Gretsch are under investigation and remain clear to race.
Summary
This practice involves extracting a small amount of blood and shining ultra violet light on it. Any benefits are questionable and if done out of competition I’m struggling to find the doping advantages; but if done five minutes before competition then it’s suspicious.
But with the older versions of the WADA code any of the athletes involved should be able to avoid a sanction with the help of a good lawyer. The case will rumble on in Germany but, for now at least, the headlines – with tales of blood manipulation – are more shocking than the underlying story.
My hot tub also has a uv filter to kill bacteria.
My hot tub has a uv filter to kill bacteria.
The WADA rules, then, would make plasma donation illegal for sport? (In this, whole blood is removed, plasma spun off, and packed cells with some saline are returned.)
I was wondering this just last week, while sitting in the chair. Perhaps I’d better not tell my club!
I also think that this is quackery (re: @hkoene). There are no benefits to this that I know of. This sets off two disturbing alarm bells either:
1. These cyclists are so desperate for any possible advantage that they’ll try any kind of nonsense from “healthcare professionals”. That is worrying in itself – what else have they tried to gain an advantage?
2. This is just a cover for good old fashioned blood doping. Admitting to a “lesser crime”…
Very disappointing news.
I have never heard of UV blood irradiation being used as a therapeutic procedure for any one of the benefits that you list in nearly 40 years of UK hospital medical practice. Unfortunately this does not mean that it is not in use in the old Eastern block countries where I suspect such practice comes under less scrutiny than in the majority of Europe. From a theoretical point of view I also struggle to see how taking a relatively small (up to 50 ml) sample of blood and irradiating it can improve global oxygen delivery or improve the microcirculation. These may be experimental effects but I suspect they do not translate into clinical practice.
however what is concerning is the intent of the athletes concerned who must be particularly naive if they thought that such a process might not be open to question or be illegal.
Well,
what is to me the bigger deal is the impact on the German cycling fan, cycling coverage, and the overall reception the sport receives (in what should be cornerstone country for the sport).
There’s some questions for the German Olympic program too.
Even if this is ruled legal, what the hell were they doing sending their athletes to a doctor recommending treatments that a) were clearly skating right at the edge of the anti-doping rules, even in 2008, and b) appear to be a long way outside standard medical practice (to put it politely)?
Australia’s Olympic athletes (including the track cycling program) are heavily supported by the Australian Institute of Sport which has a a pile of government funding to hire coaches and sports scientists. Taking the moral questions out of it for a moment, putting their athletes at risk of lengthy suspensions for a treatment of such apparent ineffectiveness is not a mistake you’d expect a doctor who was associated with the program to make.
What is the state of Germany’s Olympic athlete support program? Is it lavishly funded and centrally run like the Australian or perhaps the British, or is it a shoestring operation?
@Chris Little, I would read it as ““sequential withdrawal, manipulation and reintroduction”.
So, you should be fine to donate plasma, just don’t try and put any of it back in.
CAS decision on the Austrian skiers case from 2002 winter olympics
http://jurisprudence.tas-cas.org/sites/CaseLaw/Shared%20Documents/389-393.pdf
Anon: I share your fears.
Kevin G: it’s more I’m quoting from a paper from the 1940s that has since not got much traction to put it mildly. In stronger terms, nobody’s ever replicated the same claims.
Robert Merkel: at a tangent to your statement, note the CAS has ruled that athletes proving they followed official advice, eg national team doctors, have been cleared of wrongdoing by the CAS because they placed their trust in officialdom. Or at least some have been able to get cleared thanks to this, it is obviously not universal.
andrewp: interesting and the German TV reported cited the past practices.
hmmm I wonder if tanning beds help you go faster?
The last comment regarding a tanning bed is interesting, as I just quickly searched Pubmed for relevent articles, and found one that suggests that whole body UV irradiation (i.e. a tanning bed) can shift the oxygen dissociation curve to allow more oxygen release at tissue level! (Humpeler E, Mairbäurl H, Hönigsmann H. Effects of whole body UV-irradiation on oxygen delivery from the erythrocyte. Eur J Appl Physiol Occup Physiol. 1982;49(2):209-14.)
More striking is that most data regarding the use of this technique is from Russian journals from the 1970s through the 1990s, for the treatment of everything from infection, to poisoning, to even symptomatic coronary artery disease (I’m a cardiologist, and I find this last one particularly amusing).
I found nothing in regards to improving athletic performance in any way. However, Pubmed only searches journals that require peer review for publication, and a lot of these doping strategies don’t come through the regular scientific pipeline.
I am every skeptical, and am always surprised at what some athletes will do to obtain shortcuts for performance.
Perkstervt, excuse my high-school physiology here, but could such improved oxygen release at tissue level theoretically improve endurance?
I hope it isn’t so, or if such an effect exists it is too small to be of practical importance given that most endurance athletes in summer sports are exposed to substantial (and potentially dangerous) amounts of UV already.
Otherwise, here comes a cluster of melanomas in endurance athletes.
Merkel: maybe the southern Europeans and Californians don’t naturally look tanned 😉
On a more serious note, the paper suggests a correlation (note this is not cause and effect) between use of whole body UV and a change in the level of 2,3-DPG. Increased levels of 2,3-DPG promote more release of oxygen in tissues, but there are multiple causes of increases. These include lower pH, chronic lung disease, or congestive heart failure. My bet is the effect is, as you say, too small to be of practical importance. It’s probably some effect of the damage of UV on the skin causing local increases in stimuli for 2,3-DPG levels to increase.
One other thing to note, when you increase oxygen delivery (by lowering the affinity of hemoglobin for oxygen) at the tissue level you may potentially decrease effective oxygen transfer into hemoglobin at the site of atmospheric exchange in the lungs.
Wow, this UV irradiation of blood sounds pretty mental, I can’t believe that there are any beneficial effects and the fact that all the quoted papers are over 30 years old stands testament to that. The fact that stands out for me is that in the lab we protect ourselves as much as possible from UV when visualising DNA gels or sterilising to prevent burns and due to the obvious risks of cancer from UV over-exposure. The whole story is very bizarre.
Seems like German media turned into private agent to uncover / Undo cycling . what annoying they use cyclist as head liners whilst a list of footballers / skiers and athletes practising the same.
Wouldn’t it be nice if controls worked so well that any form of doping was avoided for fear of being caught? Then the crooked docs and such could do like Tricky Ricky Virenque’s pal and inject him with saline instead of the super-dope he begged for. Ricky came back reporting wonderful effects though they were clearly all in his head. Maybe this UV snake-oil treatment comes under that category rather than actual performance-enhancement? What’s the old saying, “50% of the sport is half mental”?
Don’t be fooled: for blood irritation you use the same instruments as for good old blood transfusions. The main difference lies in the time between drawing and reintroducing of the blood.
Who really would be surprised if the lab has a fridge and the “athletes” (or should I say “professionals”?) came back for a second visit a couple of weeks later?
Uli: true and that is a worry given others have caught been using this technique in the past. But if this was so there could be more to investigate, from storage facilities to money transfers and more. As well as the ARD TV show the authorities are investigating this.
Let’s not forget that the one and only criterion that should be used to ban a performance-enhancing treatment should be its proved harm to the health of the rider. Is blood irradiation in any way dangerous for the health?
Bundle- you’re opening a large can of worms with this claim, as there are endless arguments about “proved harm to the health of the rider” used to justify doping. After all, Dr. Ferrari claimed EPO was no more dangerous than orange juice, but most agree it should not be permitted. Even IF the lack of harm could be proved from using banned substances under medical supervision, what about the poor people who may not have access to the skilled docs and decide to DIY? Especially those who think “if some is good MORE must be better”? I believe there ARE other valid reasons to ban performance-enhancing drugs for the same reasons using a motorcycle is banned. The rules (including antidoping regulations) are artificially imposed handicaps and the sport is about who can perform best while being handicapped in this way. Getting from point A to point B the fastest is not the objective – it’s doing it while pedaling a bicycle (controlled by regulations so recumbents and wind-cheating fairings are banned) while in a physical condition free of a large list of banned substances. There would certainly be less physical “harm” to the athlete if he or she simply rode a motorcycle instead of sweating away on a bicycle, but that is different challenge…. and a different sport.
The irony here is that the German public broadcasters have been so effective in their investigation of doping in cycling that there are no fans left here to shock!!
Bundle: as well as Larry T’s comments (and he hasn’t covered all the reasons why the use of PED’s should be restricted) the question of whether this technique *should* be illegal is basically a separate one to the question of whether it was illegal at the time, and is illegal now.
Mr. Merkel: granted. But I was just asking if blood irradiation is bad for the health or not. Knowing the rules and enforcing them, does not rule out questioning them.
Larry T.: You say that there other criteria than health to ban treatments. I see you really only mention one: the cost, and subsequent unequal access by competitors. But the same logic would apply to material (what about the poor guy who cannot get the best bicycle), ain, indeed, about the pro condition (what about the poor guy who cannot devote all his time to improving his capacities). Well, no one said that sportive competition should take place in equal economic conditions. The other element you mention is the “definition of cycling”. Well, cycling is defined by a person on a bicycle. You can narrow the definition of bicycle, and thus justly rule out the use of an engine. But you cannot narrow down the definition of person. A human being always remains one, regardless of what he puts in his/her body. Doped cycling can be illegal, but it’s always cycling. We can’t play with the definition here.
Sorry for the long comment.
Bundle, no apologies needed for a long post, one of the nice things about the folks who comment here are the well-thought-out and carefully-crafted posts. Much better than “You suck!” and “NO, you suck!” as on so many other comments pages. You are correct about “doped cycling can be illegal, but it’s always cycling.” But that’s exactly my point, while it IS cycling, it’s not SPORT. Riding your moto around the hills of Mugello is motorcycling but putting numbers on and going to the Mugello racing circuit (where the rules are clearly defined) and participating in an actual race is SPORT. I’m trying to define sport here rather than “play with the definition.” Does that make it any clearer? My wife’s the sport philosopher, I’m just a bike mechanic and tour operator so I apologize if it wasn’t explained clearly in my previous post.
Thank you for the reply, Larry T. Definitions of sport are quite loose and vary from one dictionary to the other, and from one language to the other. I would readily agree that setting limitations to the use of the body is in the nature of the rules of most sports, like not using your foot in basketball. But I would question that setting limitations to products and therapies is intrinsically in the nature of cycling as a sport. For very long there were no limitations, and limitations were introduced, solely, in order to protect the riders’ health. And to me this remains the only valid reason for such prohibitions. If a new substance or procedure comes up, that improves performance, slightly or massively, with no adverse effects on the health, I see no problem.
But I am sure your good luck allows you to spend splendid hours with your wife discussing this topic. 🙂
I have read in several reports that the technique is frequently used in Eastern Europe. I’m no German, but Erfurt is in Eastern Germany, and even while it is a national facility, there might still be regional differences in the treatments given / used to patients. Historically, the treatment might be more common there.
My point is, that I don’t think the athletes are to blame for this. They shouldn’t just be viewed as athletes who are responsibly for every substance that enters their body, but also a patients. They don’t have any sort of medical training and they can’t be expected to.
Bundle- here’s a link to one of her early books http://www.cap-press.com/pdf/1169.pdf for a good overview on sport. More centered on doping is this one http://www.routledge.com/books/details/9780415484664/
I’m very fortunate to be able to easily read these and argue with the author or editor!
Has there been medical research that suggests injecting dead bacteria or inactive virus into the human body illicit an immune response that prevents or minimizes infection when exposed to live pathogens? Oh wait, we can that inoculation.
Having lived in Germany for a number of years, I am well aware that the nation takes a very broad approach to medicine. Their medical professionals are often as well versed in Homeopathy, Chinese herbs, Chiropractics and other non-traditional forms of medicine. It rather refreshing.
One is left to wonder, did Dr Franke uses the same treatment for non-athletic patients. Does he believe the irradiation of a very small fraction of a patient’s blood benefit their health through curing or preventing infection. Although he was responsible for providing medical care for German Olympic athletes, he must have had a private practice that would reveal how he used the treatment.
Well, yes there has been loads of research into immunology! by private pharmaceutical companies, academics and governments.
anyway remember all those sports people wearing those hologram wrist band things! Anything for that extra edge.
oh dear things are getting out of hand here. Protecting riders health, the definition of sport………if you start a race with the intention of doing what you can regardless of how much or light your bike is or how much free time to train and one of your fellow competitors has the same intention except he/she is also are full of medicine, then how would that make you feel about your intentions in the first place? Pretty pointless no? However if had the lightest bike would you be the fastest? If you trained more that the others, then fair play to you, you found the time, maybe you are unemployed, maybe you are a pro, but if you trained the most, maintained the best diet and sport the lightest bike (more than likely you are pro) but one of you racing opponents did the same and is filled with medicine…..?…..it’s about choice, the right to be as good as you can be and not be beaten by a guy who chose a syringe on top of everything else and rides you off his wheel to raise an arm or two. Anyone out there who is clean and competes will relate to how that can make you feel, and will undoubtedly be able to define sport clearly and know what the hell it is they are trying to protect.
My hands go a little twitchy when people start relying on technicalities. If you have to pull out the rule book, its probably not in the spirit of the game.