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In Blood Stepped: The History Of Blood Doping In Sport

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Re: Re:

08 Jan 2018 23:33

fmk_RoI wrote:I'd forgotten about this, and I'd even contacted the author to see what - if anything - new he had. Had hoped he'd have something new, given how the abstract claimed "the author had a medical role at each of the Olympics that is discussed."

Because that peer-reviewed paper was unsurprising doesn't mean that he couldn't have any more detailed insight on the matter, he apparently has his interest in the blood doping subject stemming from somewhere and he seems to have commented even earlier on the PED topic and the prestigious jounal The Physician and Sportsmedicine (1983: 11:8, 131-145) has the take of four specialists on how the hormone subject should be dealt with and K.D. Fitch is one of them (the other three being Daniel F. Hanley, E.C. Percy and Herman Adlercreutz)

I should add that he was very cordial in his reply when I wrote an e-mail to him a week or two ago pointing out a few minor errors and omissions in his paper.
User avatar Aragon
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Re: Re:

20 Apr 2018 09:11

Here is one item relating to the intellectual history of blood doping.

Even when there does exist some gossip about athletes using transfusions already in the 1960's, the consensus view is that these claims are unreliable because blood doping was "invented" only in the early 1970 and there was no blood doping research published before that decade. But there was some vaguely blood doping related research preceding the 1972 study as CN readers know from the FMK's transfusion-article:
The first scientific studies to highlight the possible sporting benefits of transfusions appeared after the end of the Second World War. These studies were not aimed actually at sportsmen but came out of the military and were aimed at ways of combating hypoxia...

The next major study on the beneficial effects of transfusions came in 1960 when Gullbring et al published their paper The Effect of Blood Volume Variations on the Pulse Ratio in Supine and Upright Positions and During Exercise. This was based on the transfusion of 610ml blood one week after extraction. In 1966 Robinson et al published another paper, Circulatory Effects of Acute Expansion of Blood Volume based on a study transfusing 1,000ml of blood two weeks after extraction. Both Gullbring and Robinson's studies showed only marginal post-transfusion gains – two to three per cent – in endurance or VO2 max.

Of the two 1960's studies the 1960 study (Gullbring et al) is even somewhat interesting, because it originated from Sweden and one of its authors (B. Gullbring) coauthored blood doping research later with Björn Ekblom, who is usually mentioned as the "inventor" of blood doping. Still it is practically forgotten study by now and most people know about its existence only from secondary sources, such as from the reviews of the blood doping literature by exercise physiologists such as Norman H. Gledhill and James Stray-Gundersen. One can also confidently claim that the modern view (vouched for by FMK) that there was practically no performance benefit found in the 1960 study is almost always based on Gledhill's paper from 1982 who claims that the performance increase was only 3 % and not significant when he listed the available blood doping research papers.


According to Gledhill, if one did read the study in the 1960's, he shouldn't have been impressed about its findings. But there are still two problems with the Gledhill's assessment even when he is mainly correct in dismissing the significance of the study:

1) The elevation in performance was more than his figure of 3 %, a figure that doesn't originate anywhere from the study. In fact, if one measures the power output of the subjects at constant submaximal heart rate of 170 BPM, the increase in performance from pre-blood withdrawal to the post-infusion is 9.4 %, from 194 to 212 Watts. It is still true that there is no statistical analysis performed and it must've been very underpowered study due to large variation in response and only six subjects. (see the figure below)

2) When the efficacy of blood doping was under debate in the 1970's and it was customary to make crude lists of the earlier handful of transfusion studies where benefit was seen where it wasn't seen, the study was almost always under the former category even when the researhers usually concluded that there were some other factors than blood volume/hemoglobin variations explaining the results (training effects, small cohort etc).

The study itself is strange not because of the protocol but because of the findings. The researchers took out 10 % of the blood volume of only six subjects and reinfused it back only a week later and conducted several exercise tests at 1 h, 2-3 days after the blood removal and right before and after the reinfusion. As should be expected, the performance of the subjects fell significantly after roughly 10 % of the blood was removed, but it returned to the original level in only 2-3 days and had risen 5 % above the pre-withdrawal level in 6-7 days when the hemoglobin level hadn't recovered at all. When the blood was reinfused at this point only after a week, the performance was elevated some 4 % more. That is to say, a huge 9 percent increase in watt output even when the hemoglobin level hadn't increased at all and had only been recovered to the starting point as the time gap between blood removal and reinfusion was only 7 days.

Effect of blood removal and reinfusion on work capacity during the Gullbring study. Left is PWC170 (power output at heart rate of 170, pre-blood removal = 100), below is time, arrow down means the blood removal and arrow up is the reinfusion. Black line represesents the mean of the six subjects whereas the coloured lines are each individual subject. The chart looks nothing like the schematic blood doping charts where benefit is seen after reinfusion (e.g. Gledhill, 1982, p. 185).

The training effect is the most obvious explanation for the strange results and even when one doesn't fully know what to make of the findings, the existence of this research paper might've been known even widely, because - unlike the transfusion reserach of the 1940's at the Bethesda military hospital - this was a research on the exercise physiology and many of its authors were exercise physiologists and the paper was published in a prestigious journal where P.O-Åstrand and his colleagues published regularly.

In addition, the key findings of the study were discussed at the 1958 meeting of the Swedish Medical Association under the extremely blood doping sounding title "Fysisk arbetsförmåga efter blodavtappning och retransfusion" (Physical capacity after blood removal and re-transfusion). As an interesting anecdote, when Björn Ekblom, Bengt Gullbring [sic.] and Alberto Goldbarg published the "first" blood doping study some fourteen years later, it was titled "Response to exercise after blood loss and reinfusion" using almost exactly the same title.

As another anecdote, I can recall a few years ago discussing the subject of blood doping with one prestigious Finnish sports journalist and biographer well-connected with the circles specifically in the 1960's and 1970's and showing him a paper copy of the Gullbring-paper. He instantly recalled the study having being discussed on some level even even when he had never seen a copy of it. Too bad he didn't specify whether it was discussed already in the 1960's or only later, when there was other blood doping research originating from Sweden.

If one can't conclude too much about the 1960 paper, the least one can conclude is that the method of transfusion found its way into the exercise physiology-related research and into the journals of the field.
User avatar Aragon
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