Can EPO Kill?

Introduction

Once in a while I read a magazine article that gets my dander up.  In such cases I may offer a rebuttal in these pages, not because my readership is vast, but because the offensive writer might see my post and decide to go toe-to-toe with me.  I’d love that.

In this post I take on Mark Johnson and his VeloNews article titled “Book Excerpt:  Dr. Ferrari Was Right,” published on July 8, 2016 and updated on March 15, 2017.  The title refers to the disgraced cycling team doctor Michele Ferrari and his infamous quote about recombinant human erythropoietin (EPO), the drug of choice among cheating cyclists, being no more dangerous than orange juice.  Johnson makes the interesting observation that while EPO use is widely associated with death by heart attack, no causality has ever been established.

If this observation had been made in a brisk 200-word essay, I’d be grateful for it—I appreciate having a myth debunked.  But Johnson’s annoying and tedious 6,500-word article goes way too far, slinging mud at anti-doping journalists and anybody else who still thinks cheating is lame.  Read on as I savage Johnson’s essay.

Repetition as a rhetorical technique

In  junior high we all learned the basic essay formula:  state your thesis; support it through a number of examples; then restate it in your conclusion.  Those of us lucky enough to get more advanced instruction learned to mix this up a bit.  For example, you might skip the up-front thesis statement, presenting information that gradually leads the reader to come to your thesis on his or her own; following this, you can state your thesis at the end or even leave it merely implied.  Most good nonfiction writing does some version of this.

Johnson, however, gets to the point early on and then beats us over the head with his assertion, no fewer than 16 times by my count.  He starts with this:  “While the Dutch riders Rouet referred to were never conclusively linked to death by EPO, the fabrication served a larger anti-doping moral agenda and the missionary effort to impose purity on sport.”  As he develops his essay he reminds us of his position again and again.  Here are some examples: 

• “The story’s claim that the drug was responsible for 18 cyclist deaths was based on speculation”
• “What was not provable in 1991, or today, is that the drug killed a rash of cyclists”
• “EPO deaths made for good news stories, even if there was no autopsy evidence that EPO was actually killing cyclists”
• “No evidence exists to support the claim that EPO caused any of the cyclists’ deaths in the early 1990s”
• “Turning back to the EPO fiction”
• “While there is no evidence directly linking EPO to any competitive cyclist deaths in Europe”
• “The EPO-kills fabrication”
•  “The fictional nature of drug-death stories”

Okay, we get it, dude!  It’s almost as though Johnson is hoping by sheer repetition to get our heckles up against this confusion of anecdote with science.  I might start to feel annoyed by all the journalists who conflated correlation with causality, except I’m far more annoyed by Johnson’s logorrhea.  Fine, state your thesis at the beginning and the end, maybe even at the 3,000-word point just in case we forgot.  But 16 times?  What, do you think your readers all have ADHD?

Bludgeoned by evidence

To Johnson’s credit, he does back up his assertion by citing many articles that promote the EPO-equals-death idea without providing solid evidence.  A couple of illustrative examples, and allusions to other articles, would have convinced me that this unproven assertion is widespread.

Unfortunately, Johnson feels the need to bolster his case again and again, delving at length into seven different articles, along with a painstaking analysis of the matter by Bernat López, a Spanish professor similarly fascinated by the tendency of journalists to perpetuate one another’s hasty conclusions.  López must have even more time on his hands than Johnson, as he did a “meta-analysis” of 56 “academic texts” on this issue:  36 citing the dangers of EPO, and 20 arguing against the claim that EPO has killed cyclists.  Johnson blathers further by restating López’s conclusion—that no hard evidence causally links EPO with cyclists’ deaths—four times.

How much evidence do we need?  This overabundance of refutations turn Johnson’s article into some kind of journalistic Whack-A-Mole.  Okay, fine, nobody has proven EPO is deadly!  We get it!  Why go on and on like this? 

The answer to this question, I assert, is that Johnson wants to lead us toward a more subtle thesis, which he doesn’t support nearly so well, and which ultimately pisses me off.  Let’s sneak up on this hidden agenda by exploring some more of Johnson’s journalistic missteps.

Sensationalist language

Throughout his story, Johnson does a most curious thing:  while paraphrasing other journalists, and insinuating that they’re resorting to sensationalism, he employs sensationalist language of his own, again and again.  When he occasionally quotes an article directly, I see a striking disparity between the other journalist’s language and Johnson’s.  For example, a New York Times writer states that “the consequences [of EPO abuse], in some cases, may be deadly.”  Johnson sums up the article with this zinger:  “The New York Times startled readers with news of a killer stalking the roadways and velodromes of Europe.”  A killer stalking the roadways?  Seriously?

A caption in the same Times article read, “Mr. Draaijer’s widow believes that the drug recombinant erythropoietin was involved with his death.”  The Times later ran a correction, acknowledging that this caption reflected mere speculation on the widow’s part.  Johnson’s conclusion:  “Despite the correction, the rumor was already set:  EPO was a new drug of athlete destruction.”  Johnson, calm down!  Stop being so dramatic!

Here are some other examples of Johnson’s bombastic language:

• a killer set loose among the peloton
• scary new athlete killer
• a mass killer
• Grim Reaper haunting bike races and marathons
• press-supported notion that EPO was indiscriminately slaughtering cyclists in the early 1990s
• EPO’s black reputation in sports as a drug of mass destruction
• colorful, body-strewn doping history

By employing this kind of language when paraphrasing the articles he denounces, Johnson is committing an aggregate “straw man” fallacy:  he presents a weakened (in this case exaggerated) version of his opponents’ arguments in order to knock it down.

Johnson doesn’t include hyperlinks to the articles he cites, and I couldn’t find all of them, but I did check out the New York Times article.  Nowhere did I find anything like Johnson’s hyperbole.  I found responsible, carefully worded but qualified assertions:

• Doctors and blood specialists say the drug may be implicated in the deaths of as many as 18 European professional bicycle racers in the last four years
• Only anecdotal evidence links EPO to these deaths
• An autopsy did not specify the cause of death

I also happen to have clippings from two other articles on this topic.  While they both do suggest a link between EPO use and death, their wording is also cautious and understated, exactly as you would expect from a responsible journalist.

For example, “Cycle of Tragedy” by Ron Kroichick in the San Francisco Chronicle, May 9, 2004, states, “The absence of definitive causes ... underscores long-standing suspicions about performance enhancing drug use in cycling.”  While his article suggests a link, Kroichik never uses sensational language like “scary new athlete killer” or “drug of athlete destruction.”

Similarly, in “The Hardest Test,” in The New Yorker, August 21, 2000, Julian Barnes writes, “The assumption was that [the athletes’] heart rate had dropped during sleep and became simply insufficient to pump the blood. To counter this, EPO takers were said to get up in the middle of the night to exercise.”  Note the careful language here:  “the assumption was” and “were said to.”  Barnes doesn’t even assert that these reports can be proven. They lend themselves reasonably well to hearsay, but not to being substantiated.  After all, what athlete would go on record saying, “Yeah, I get up to exercise during the night because of all the EPO I take”?

An inconvenient truth

While Johnson derides the idea that EPO killed athletes, he does concede that the notion isn’t far-fetched.  He quotes hematologist Dr. Allan Erslev as saying, “The combination of lower blood volume from dehydration and higher hematocrit from EPO would increase blood viscosity and be not only detrimental to muscular action but also the cause of possible life-threatening thrombosis.”

Beyond this—and flying in the face of his earlier naysaying—Johnson concedes, “My own search of medical literature finds plenty of warnings about the dangers of too much EPO…. A 1996 study of dialysis patients was halted because patients on high EPO dosages suffered more heart attacks than a control group on lower amounts of EPO.”

Now, wait a second here.  If we have substantiation of the various claims that EPO thickens the blood, and medical research does show a link between EPO and heart attacks, is the implied causality in the death of these cyclists really so absurd?  Is it really “fictional,” a “fabrication,” a “fable,” and a “myth”?  Johnson makes no effort to explain why nothing has been proven in the case of cyclists, as though EPO’s risks didn’t have solid medical evidence behind them.

Does it really not occur to Johnson why this evidence doesn’t exist?  Has he not considered that team doctors of deceased athletes would prefer to sweep their EPO use under the carpet?  Has he not contemplated that when a cyclist dies and his family is grieving, no authority wants to step up and say, “Hey, if it’s any consolation, this guy was a lying cheating scoundrel”?  The governing body of cycling, meanwhile, has been infamously good at looking the other way when it comes to doping.  So the real question is, who exactly was supposed to come forth and investigate these deaths?

Sure, journalists would love to cry foul, but how are they going to gain access to damning evidence?  Who is going to let them snoop around the cyclist’s deathbed?  Johnson complains when an autopsy isn’t carried out (“there was no autopsy evidence that EPO was actually killing cyclists”), but as the Times writer pointed out, this causality cannot necessarily be established by an autopsy.

Meanwhile, what other explanation has been offered? If EPO didn’t kill these athletes, what did?  Did they drink milk from rbGH-treated cows?  Did they microwave food in plastic containers?  Did their parents just not love them enough?

(Johnson does offer up one theory, suggested by López and his survey of EPO research:  “If the researchers behind the 20 papers came up with any one Grim Reaper haunting bike races and marathons around the world, it was the damaging effect of extreme and prolonged training.” Well, isn’t it easier to train yourself to death when you’ve used EPO to speed your day-to-day recovery?  Maybe the relatively slow replacement of red blood cells is nature’s way of giving athletes the rest they need.)

Is death the only reason to condemn EPO?

Okay, let’s set aside the possibility that EPO has actually killed anyone.  Let’s assume, for the sake of argument, that EPO is never fatal.  Does that mean it’s okay?  Is that what Johnson is trying to say?  He seems inclined to vindicate the illegal use of this drug.  His vitriol verges on mocking the antidoping effort—not its efficacy, which is an easy target, but its very aim.

The height of this strange attack is a statement Johnson cites from López:  that “because the general public is largely indifferent to the drug-regulating policies that are the bedrock of anti-doping organizations, anti-doping missionaries played up the deadly EPO myth as a way to gain sympathy from a public that has an otherwise insatiable appetite for legal and illegal performance- and lifestyle-enhancing drugs.”

Granted, this is López’s assertion, but because Johnson trots it out (without calling it out as the raving of an obvious dipshit), he seems to agree.  WTF?!  Since when does the public have this insatiable appetite for drugs?  I don’t!  I want to see clean athletes!  The anti-doping “missionaries” (you can just hear the contempt in López’s voice) have had my support (or “sympathy,” if you must) all along.  I don’t agree that the public is against doping controls, and moreover I don’t believe that the public would demand the risk of fatality as a prerequisite for getting on board with an end to doping.

To his credit, Johnson does a fine job of explaining how EPO overrides the body’s natural ability to regulate blood cell production.  But he doesn’t seem to grasp, or at least acknowledge, that this is a very scary proposition.  Perhaps he never read Matt Rendell’s chilling article about Marco Pantani, “The Long, Lonely Road to Oblivion,” in The Guardian (March 7, 2004).  Check out this bit about what doctors found when, after a terrible crash, Pantani was admitted to an Italian hospital for multiple compound bone fractures: 

On his arrival at Turin’s Centro Traumatologico Ortopedico at 3.20pm, doctors were startled to discover blood values that were abnormal, almost bizarre: his haematocrit, or red cell count, was 60 per cent (50 per cent is high); his haemoglobin was 20.8g per 100ml (18g is noteworthy). These values then plummeted: on 25 October, with 15.9 per cent haematocrit and 5.8g haemoglobin, it took a transfusion to save his life.

After which the anaemia miraculously cleared. Someone, it seemed, had injected Pantani with the genetically engineered blood-booster erythropoietin, known in sport as the doping agent EPO. At the age of just 25, Pantani’s body had grown so dependent on these injections that it could no longer produce red blood cells.

Oh. My. God.  To tamper with the body’s ability to regulate blood cell production doesn’t sound safe whatsoever, whether it actually kills you or not.  Why does Johnson hold out for proof of fatality?  Isn’t EPO scary enough as it is?

What really gets me about Johnson is his scornful attitude toward the anti-doping mentality, and his insistence that raising suspicion about unsolved deaths in the EPO era is somehow more irresponsible or unfair than the EPO use itself.  “The fiction served as propaganda,” Johnson whines, “that made it professionally and personally suicidal to challenge the morality and righteousness of the antidrug movement.”  Isn’t the antidrug movement intrinsically moral and righteous?  On what moral ground could a cyclist challenge drug controls?  Do we have a God-given right to cheat by using dangerous drugs?

I struggle to understand what Johnson is really after here.  What version of cycling would he prefer?  A sport where those willing to take the greatest risks to their health (and their livelihood) are allowed to dominate, with a crushing, tactically minimalist style of putting all their doped teammates at the front of the pack and grinding everybody down until nobody is left to challenge their doped-to-the-gills leader?

I love this sport because, as a former racer with a sadly meager hematocrit, I found ways to succeed through grit, perseverance, patience, teamwork, and tactical acumen.  As such, I want to see all kinds of racers have a chance, not just those who respond particularly well to drugs.

For Johnson to attack the anti-doping movement, on the basis of insufficient evidence of EPO’s role in the deaths of cyclists, is seriously off-base.  I’m offended by his snide attitude, his bombastic and sensationalist language, and his audacious attempt to claim the moral high ground.  I hope Johnson’s book tanks, and that nobody mistakes his dogged rhetoric and tedious repetition for actual logic, judgment, or insight.

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Is the Red Hook Criterium Series Good For Cycling?

NOTE:  This post is rated R for mild strong language and intimations of gnostical turpitude.

Introduction

Let’s have a little fun before burying ourselves in a lot of tedious text:

Daaaamn, is that a great crash, or what?  I could watch that over and over again.  In fact, I just did.  So did you—don’t deny it.  Really gets the pulse racing, doesn’t it?

Here’s another great clip:

Both of these fine films were shot at the Red Hook Criterium in Brooklyn, part of a series of races that require the use of fixies—you know, those track bikes hipsters ride that have no brakes and don’t allow coasting.  Racing theses bikes on regular streets, instead of on a velodrome, has proven a great formula for generating lots of crowd-pleasing danger.

Is this kind of racing a good idea?  Should it be promoted, or banned?  That’s what I’m exploring with this post.

What’s great about the Red Hook series

Anybody who’s ever raced a rinky-dink criterium in some forlorn business park, with a tiny smattering of spectators (all of them related in some way to the racers) will appreciate the fact that the Red Hook series draws a massive crowd of spectators (17,000 in the case of London’s event).  There’s no doubt that this kind of race is increasing the visibility of cycling.

You know what?  I’m getting bored with all these words.  Here’s a video compilation of Red Hook crashes from 2013:

The first crash is my favorite because the (amateur) cameraman gets involved.  I just wish there was another camera angle so I could watch the third racer flip over the fence onto the guy.

What’s lame about the Red Hook series

The first lame thing about this series is that the whole premise is just so fucking stupid:  hey, let’s make riders use the wrong equipment, and race in the dark, so that there’ll be lots of cool crashes!

The next lame thing is that this race thinks it’s cool because it attracts a lot of hipster types.  According to this Velonews article, “[Director] David Trimble held an unsanctioned, late-night race in Red Hook as a challenge between bicycle messengers and local road racers” and “required everyone to compete on a brake-less fixie, the preferred tool of bike porters.”  Of course once the race got big, the messengers were no longer much of a factor, because we all know bike racing is for the idle rich, who have time to follow special training plans involving “efforts.”  And yet, having started out as this illegal underground thing, the race desperately clings to a self-professed rebel mystique.  This “teaser” documentary by Trimble, with its self-satisfied air, almost made me throw up into my mouth. Of course it doesn’t mention the crashes, which are obviously the point.  It’s a little like a commercial  for Oreos that celebrates the wholesome wheat flour without mentioning the sugar and fat.

And why are fixies the “preferred tool” of tools?  Because they’re stupid and unpractical, of course.  Their unsuitability for urban riding makes them edgy and cool, kind of like cigarettes, so they naturally appeal to vainglorious image-obsessed douchebags.  Now, I want to pause here and point out that not all bike messengers are like this.  Go to New York City sometime and check out the full spectrum of messengers.  A fair number of them are just a step above homelessness and ride really crappy department store bikes worth less than the lock they’re secured with.  I saw one poor dude who had to make do with a girl’s model.  Not all messengers are narcissistic curators of their self-important self-image.

I realize I’m getting into slippery territory here … if I don’t like fixie-riding hipsters and the lycra-kitted bike dorks on $5,000 carbon-wheeled track bikes who weirdly seek to emulate them, shouldn’t I want to watch videos of them crashing at high speed?  Fair point.  In fact, when I watch that first video, I can’t help but be annoyed that it’s not edited more tightly.  Check out this video here and you really appreciate the impressive capabilities of modern video-editing software.  Why does this albeit spectacular bike crash video run for a full 43 seconds, when all the worthwhile action is over after the first 11?  Meanwhile, the auteur obviously isn’t a bike racer himself because he fails to pan correctly and we miss part of the crash.  About 6 seconds in, you can hear the telltale sound of a riding going down, just out of the frame, but the cameraman doesn’t react.  It’s a good thing more guys stacked into the first guy, or we’d have missed the whole thing!

So yeah, there’s a part of me that says we should promote, and indeed enhance, this version of the sport.  What I’d really like to see is one corner without fencing, where they periodically allow spectators to blast racers with a fire hose.  Wouldn’t that be spectacular?  Or once in a while they splash oil across a corner.  Of course, the spectators shouldn’t be off the hook here … they need to get involved in the carnage as well.  Why not get a booze sponsor involved, and create a drinking game for the spectators?  Every time there’s a crash, everybody has to do a shot.  When some bozo gets sufficiently drunk, a course marshal opens the fencing and pushes him out into the street where he wobbles around a bit until a rider slams into him.  Now we’re talking!

But that’s not actually where this Red Hook series is heading.  Naturally, as it grows and attracts money, it becomes more mainstream, despite what the director would have you believe.  According to this article, “Trimble, who first organized the race in 2008 as a celebration of his birthday, said he consciously tries to balance the race’s grassroots feel with its growing popularity.  ‘As for people saying the atmosphere is getting more mainstream, it’s not like we have a bank sponsor,’ Trimble said. ‘It’s gotten bigger but believe me, it’s grassroots.’”

Okay, first of all, what kind of self-absorbed dickwad orchestrates his own birthday celebration?  Second, his “bank sponsor” comment is obviously bullshit given the event’s current “six-figure sponsorship portfolio.”  If Rabobank or Citibank offered shitstacks of money to grow the event, Trimble would accept it in a heartbeat.  And “grassroots” generally refers to an idealistic campaign to change society in some useful way.  How is a bike race designed for maximum crashes achieving that?

The biggest problem with Red Hook

Imagine if, after you watched that first crash video a dozen or so times, and forwarded it to all your pals, somebody told you, “Hey, you know that second guy who went over the fence?  He ended up a quadriplegic!”  Suddenly this wouldn’t seem like such fun, would it?  And racers do get maimed.  As described here, a 15-year-old Red Hook participant had a terrible crash, was unconscious in the hospital for two weeks, and had to have “his face rebuilt with 23 screws and numerous metal plates.”

Yeah, I know, crashes do happen in traditional bike races, but not nearly as often since racers are allowed to use proper (i.e., road) bikes.  When you watch a normal criterium, the compelling spectacle isn’t how many riders crash, but how many don’t.  Go watch the Nevada City Classic criterium sometime, and watch how expertly the racers carve the sharp downhill corner.  I wouldn’t take my family to watch this race if I thought it made cycling look dangerous ... I mean, why would I, when I’m trying to encourage my daughter to race, and my wife to let her?  A real criterium, where riders can modulate their speed and keep that inside pedal up through the corners, demonstrates how safe cycling can be, even at high speed.

The Red Hook series, on the other hand, gives newcomers to the sport some cheap thrills while painting a picture of cyclists as total madmen.  Comments on the Red Hook crash compilation video  include innocent questions, e.g., “are these bikes designed for racing?” and “why do they race at night?” along with typical inane comments, e.g., “Brooklyn girls be super ugly!!!” and “Y you crash bitch you only doing 5mph on the stupid turn.”  Clearly these are not cycling aficionados.

Is it just me, or is there a fundamental hypocrisy in play when an event that calls itself “grassroots” actually undermines the idea that cycling can be a safe, responsible activity?  As a person who wishes lots more people rode bikes instead of ensconcing themselves in giant SUVs, I think watching a bike race should make people want to ride bikes, not shudder and say, “Those dudes are crazy!”

And speaking of those dudes, I think it’s pretty disgusting that they’re willing to be led around by their egos and seduced into riding a brakeless bike, at night, in thrall to big crowds.  I’m reminded of Olympic women volleyball players who, for years, complied with the rule that they had to wear bikinis.  According to this article, one top player candidly acknowledged the mentality behind this:  “‘The people who own the sport [the Fédération Internationale de Volleyball] want it to be sexy,’ Johns told the Sunday Times. ‘I used to play in shorts and a T-shirt and was reluctant to change. But if it gets volleyball attention, so be it.’”  I can imagine a very similar quote from a Red Hooker:  “I used to ride a road bike so I could brake and coast through turns, but the race organizers want it to be dangerous.  My road rash really hurts but if it gets cycling attention, so be it.”

Does cycling need this kind of attention?

Ultimately, to enjoy watching the true sport of bicycle racing requires some sophistication.  The sport isn’t for everybody, and that’s totally fine.  Other spectator sports are subtle, too.  Think of baseball, with its bizarre tapestry of strange rules, secret signals between players, and so forth … would it benefit from a big dose of lowbrow, brute spectacle, like if after three balls the pitcher was allowed to throw the next ball right at the batter with full force?  Or if the outfield were studded with landmines?

Celebrating the crowd-pleasing savagery of the Red Hook series seems pretty pointless.  Does cycling really need to grow as a spectator sport?  I’d argue no.  What’s wrong with a sophisticated and elite—albeit somewhat rare—fan, who responds to drama, and suffering, and tactical savvy, rather than mere bloodshed?  And even if you do want the sport to attract more spectators, I doubt the Red Hook freak show is going to win over any true fans—just a bunch of looky-loos who’ll eventually get bored and wander off to go find a cockfight, or dogfight, or political rally.  I myself have a limited appetite for bike crash videos … sure, I had a little fun here, but I can’t picture myself engaging in this coarse activity for long.

I say we treat the Red Hook races the same way we treat the hipsters, with their ugly piercings, hackneyed tattoos, skinny jeans, and fixies:  that is, ignore them, and hope they just go away.

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Can Too Much Exercise Damage Your Heart?

Introduction

I get a lot of bike-related articles in my e-mail, mostly via my bike club.  When I get an article from two separate feeds, I know it’s something big.  So it was with a recent front-page story in Velo magazine, “Cycling to Extremes.”  (I read the online version, available here.)  The subtitle:  “Are endurance athletes hurting their hearts by repeatedly pushing beyond what is normal?”

What is normal?  Alas, for American adults “normal” is almost nothing; a CDC survey found that nearly 80% of adult Americans get less than 2.5 hours of exercise a week.

But forget about averages and those who don’t exercise.  The point of this Velo article is that ageing endurance athletes—i.e., guys like me—seem now to be in danger.  The article declares, “In the case of endurance athletes who have competed for years — whose hearts have exceeded the threshold of normal heart rates for decades — going above what is normal defines them.  But it may also be killing them.”

In this post I examine the reactions of my pals to this disheartening article; indulge in some knee-jerk denial; examine some other anecdotal evidence; evaluate the article’s claims on the basis of the literature cited; and (perhaps most importantly) provide a scheme for greatly advancing the study of exercise-induced heart complications among the middle-aged.

 Reactions

My first reaction to seeing this article was, “Oh, crap.  I hope nobody forwards this to my wife.”  (She’s the designated worrier of the family, which leaves me free to pooh-pooh everything.)  But then, I’ve got people depending on me, so I thought I better take the article seriously.  First I looked at how my pals were reacting.  “Hummmm....this is a little scary,” one e-mailed.  Another replied, “Yeah very scary.  I routinely get dizzy when I get up - something that’s happened my whole life but” and here his e-mail ended abruptly.  (Had he collapsed mid-sentence?)  One guy mentioned an athletic 50-year-old pal who suffers from a heart issue like what’s described in the article.  Other responses:  “I have to admit, this article gave me pause, especially the way I like to ride bikes ... hung over, and hammering as hard as possible,” and “Alas, all along I thought I was doing something good for myself.”

Of course it’s tempting to deny the whole thing.  The article has some serious flaws—which I’ll get to in a minute—and I almost shrugged and thought, “Typical FUD, designed to sell magazines.”  But I resisted the urge.  After all, just because an article is flawed doesn’t mean its central assertion is false.  Besides, I respect the cautious position my pals have taken, and this isn’t the first time I’ve pondered the mystery of brilliant athletes suddenly dropping dead.  The article mentions two marathoners who died while running, and I also recall Matt Wilson, a local rider who died while cycling in 2011, and Steve Larsen, a guy I raced with as a junior, who died while running in 2009.

Never mind that my own heart has behaved perfectly my whole life (at least, as far as I know).  It’s possible I’m doing damage now that will only become a problem in ten years.  After all, I know guys who have smoked for years but don’t have lung cancer.  Yet.

I mulled over this article for about a week and a half, and just when it was starting to drift toward unconscious dismissal, I mentioned it to a cycling friend (my age) who said, “Oh, yeah, someone told me about that but said maybe I shouldn’t read it ‘cause it might bum me out.”  Why would it?  Turns out this guy has had a heart problem for some time now:  he’ll be riding along, just cruising, and suddenly his heart rate will go from like 140 up to over 200 and stay there for 30, 40 seconds.  Uh oh.

The “lumping” problem

My chief difficulty in deciding how much to worry, and whether or not to change my approach to cycling, is that of “lumping.”  Is it right to lump myself in with the guys cited in the article, and with the marathoners, and with Steve Larsen?  Is it right to lump runners in with cyclists?  And is it right to lump various heart problems together and treat them like one phenomenon?

Let’s take that last question first.  The Velo article uses two case studies to make its case:  Lennard Zinn, who while bicycling suffered symptoms of “his heart [flopping] like a fish” and beating way too fast; and Mike Endicott, who collapsed and lost consciousness during a cross-country ski race.  Was Endicott’s heart also racing?  Well, not at first.  Endicott’s words:  “Something was beating inside my chest.”  The Velo writer describes it as “his heart still doing something strange inside his chest” which led, after an hour or so, to ventricular tachycardia and “an immediate, unexpected loss of heart function.”  This seems a lot different from what Zinn experienced.  Were these two suffering from the same specific heart problem?  It’s not clear.

The article states that Zinn was diagnosed with multifocal atrial tachycardia, but Endicott’s exact diagnosis isn’t given.  The article talks a lot about atrial fibrillation (AF):  is this the same as tachycardia?  Again, it’s unclear (though this FAQ suggests not).  Moreover, the main study the article cites concerns “myocardial fibrosis, a condition that involves the impairment of the heart’s muscle cells, called myocytes, through hardening or scarring of tissue.”  Does myocardial fibrosis lead to tachycardia and/or fibrillation?  Do Zinn and Endicott suffer from myocardial fibrosis?  Once again, the article doesn’t say.

It’s not just this article that’s vague about this stuff.  I did a tiny bit of research on Steve Larsen’s death, and turned up something surprising:

Google’s big-font summary makes it pretty clear this was a heart attack—but it wasn’t, according to the first article cited.  Nothing else has been written to further clarify this matter; the autopsy itself apparently ruled out heart attack.  And yet people seem to remember it as such.  Two years after Larsen’s death, when I was corresponding with a friend about Matt Wilson, my friend wrote, “Steve Larsen was the guy who had a [fatal] heart attack two years ago here in Bend.”  Meanwhile, I’d always remembered Wilson’s death as having been from a heart attack, but in researching this now (for example, here), I can find no specific cause of death.

A dearth of data

Let’s get back to that Velo article.  My temptation, when presented with such ambiguity, is to read the research articles on which the article is based.  But the article, while making lots of vague references to unnamed studies, doesn’t provide much.  For example:  “Over decades of exertion, the myocardial cells of the heart begin to simply fall apart, and you’re left with an unhealthy ticker. Or so these new studies suggest.”  And:  “Long-term endurance exercise results in a five-fold increase in the risk of developing AF.  A review of the relevant research finds many small studies that correlate long-term sports activity with AF....  While none is conclusive, collectively they indicate a pattern.”  What studies?  What relevant research?  There are no citations given here; no footnotes; no hyperlinks.

The article does cite two specific studies.  One involved rats, and I’m going to dismiss that.  (My heart is bigger than a rat’s; rats don’t live 40 or 50 or 60 years, which is the age group I’m trying to learn about; humans cannot be made to exercise as hard as rats.)  Velo also cites a study published in The Journal of Applied Physiology:  “MRI studies revealed that some 50 percent of the veteran [>50-year-old] athletes had myocardial fibrosis....  In age-matched controls — people of the same age who didn’t compete — and young athletes, there were zero cases of the disease. Furthermore, the fibrosis was significantly associated with the number of years spent training, and the number of marathons and ultra-endurance marathons they had completed.”

Okay, now we’re getting somewhere!  I looked at the study itself to get more information.  You can read it here.  My big issue with this study is that it only included 12 veteran athletes.  Of these, 2 had previous heart conditions (1 probable previous mycarditis, 1 probable previous silent myocardial infarction).  The Journal study is candid about its limited scope, acknowledging that “Like many studies of this type, the numbers of veteran athletes are small (largely because this is a small and unique population), and generalization is difficult.”

And yet, without the ability to generalize, what are we supposed to do with this (largely anecdotal) information?  My frustration is that I feel I ought to evaluate and possibly modify my own behavior based on these cautionary tales, but I have no solid basis for assuming that my behavior matches the profile of the overworked athlete who may be damaging his heart.

Velo addresses this problem of definition by quoting Dr. John Mandrola, a heart rhythm doctor:  “What’s too much? That’s the $64,000 question. Though I will say it’s a little like what the judge said about indecency: ‘I know it when I see it.’”  Well, this just doesn’t do me much good, because I’m not about to go to Kentucky to visit this doctor, in the absence of any symptom of any problem.

I see four possible ways to respond to this information. 

1. I could completely ignore it—but I think that’s irresponsible. 
2. I could simply err on the side of caution, and ride less often and less hard than I currently do—but isn’t this completely arbitrary, since somebody who rides twice as much as I could similarly tone it down “a bit” and still be riding way more than I? 
3. I could continue riding exactly how I currently do, while adding myocardial fibrosis to the pile of things I regularly worry about (which will increase my cortisol levels to the detriment of my health) while feeling guilty for being such a poor custodian of my body.  No thanks. 
4. I can try to get more information about this, with a whole lot more data, so I can more reasonably evaluate and (if necessary) modify my behavior.

Number four wins, and that’s where my proposed solution comes in.

The solution

We need more information!  We need more than two anecdotes and a lot of vague references to “these new studies” and “the relevant research.”  We need more than studies on rats, and we need studies of more than 10 veteran athletes.  By “we” I mean “society,” and actually society is already really, really good at harnessing massive amounts of data and crunching them to derive useful judgments.  Think of how effectively Amazon predicts what we’ll want, and how well the advertising industry can anticipate, and create, our desires.  What if we could find a ready source of “big data” for studying the effect of gonzo endurance athleticism on heart health?

But we have it already!  It’s called Strava!  This social network has 8 million registered users, of which 1.2 million are active and something like 190,000 have premium accounts.  (These are estimations since the company doesn’t reveal these numbers; click here for details.  Suffice to say, this is a lot deeper pool of data than 10 test subjects.)

 The number of Strava users isn’t even the best part.  It’s the quality of the data set.  Consider the type of athlete who goes so hard, and so long, and so often, that he or she is actually at risk of causing heart damage.  How many of this type wouldn’t be on Strava?  The gung-ho Strava cyclist is exactly the kind of person who might overdo his or her training.  In other words, Strava members comprise the perfect group for studying this stuff. 

I’m envisioning a splash screen that pops up when the Strava user logs in.  It asks, “Are you willing to participate in an anonymous study about heart function and rigorous aerobic exercise?”  I’d guess most users wouldn’t have a problem with this.  And anybody who’s having heart trouble would probably be eager to participate, to better understand it all, and could indicate the nature and frequency of his or her problem.  Such a study could quite feasibly have millions of workouts per day to crunch (the average workouts logged per day being around 6 million last year, as detailed here).  You’ve got your control group and your heart-oddity group both covered, right off the bat.

And what great data there’d be to crunch!  You get exercise frequency; exercise duration; heart rate; and history (e.g., how much a rider’s performance is improving or deteriorating).  You could start to develop very precise profiles of those whose hearts are misbehaving.  Is there an age threshold beyond which these symptoms most commonly present?  Are there frequency, duration, and/or intensity thresholds below which no errant heart behaviors are observed?  What is the rate of heart trouble for riders exactly my age, who ride (on average) just as often, and in exactly the same heart rate zones I work out in?  Of those who work out like I do but who are 10 years older, how many have developed heart trouble?  Five years from now, when we see an even more comprehensive integration of “big data” into our lives, we’d probably have even more ways to correlate the data.  (We might know, for example, whether frequent purchases at Starbucks or BevMo factor in to the cardio health equation.)

Conclusion

For now, I’m going to assume that the hectic pace of my life, my many familial obligations, my relative sloth, and my unaggressive riding style will keep my heart in good shape.  I’m not going to bother shopping my Strava idea around, because I’m confident  that the Strava folks themselves, looking for a way to actually make some money, are bound to get the attention of the insurance people, who I assume are always looking for ways to avoid open-ended batteries of complicated tests.  I envision all of this happening without any effort from me, probably years before I start getting into the dangerous years where my heart starts “doing something strange inside [my] chest.”  And if you want to forward this link around to speed up the process, please be my guest!