The Egg Conundrum

UPDATE: I’ve since written additional posts to the CVAC pod post below. Please check them out if you’re interested: 1) Here’s one about the biological passport program, that can be used to detect abnormal shifts in an athlete’s blood profile.  2) This is a short summary of what two physiologists had to say about the CVAC pod and why the biological passport system is a great method to test the CVAC pod for “unfair advantage.”  3) The third link is an additional explanation on the reported differences between the CVAC pod and oxygen tents (hypobaric and hyperbaric chambers)

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So a week ago, the WSJ ran a story about Novak Djokovic’s use of a pressurized egg called the CVAC pod. It created a bit of a stir.

The $75,000 CVAC pod device, which  is one of only 20 devices in the world, is different from the $5,000 hyperbaric chambers that are commonly used by athletes.  Hyperbaric chambers serve to “saturate the blood with oxygen and stimulate healing.”  The CVAC pod device, “is a considerably more-ambitious contraption. It uses a computer-controlled valve and a vacuum pump to simulate high altitude and compress the muscles at rhythmic intervals.”  According to the WSJ article,

The company claims that spending up to 20 minutes in the pod three times a week can boost athletic performance by improving circulation, boosting oxygen-rich red-blood cells, removing lactic acid and possibly even stimulating mitochondrial biogenesis and stem-cell production…

CVAC Systems chief executive Allen Ruszkowski says the treatment seems to have many of the same effects on the body as intense exercise. He claims that the technology may be twice as effective at helping the body absorb oxygen as blood doping—a banned form of performance enhancement.

Boosting oxygen-rich red blood cells and “mitochondrial biogenesis and stem-cell production” seems to be toeing the line of fair versus unfair advantage.  Now why the CEO of CVAC systems would try to market the device as being twice as effective as blood doping, is beyond me.  I don’t know if that’s an effective or particularly sane marketing strategy, especially in these times when doping is an ever-sensitive issue for athletes, their governing bodies, and their increasingly vigilant fans. The purported effects of this device, combined with the fact that it is much more sophisticated than the commonly used oxygen tents or hyperbaric chambers, raised more than a few eyebrows.

Per the article, “In 2006 the World Anti-Doping Agency ruled that such oxygen tents enhance performance and violate “the spirit of sport,” but did not add them to the list of banned substances and methods, saying they would wait until further studies were conducted.”

If you go to the World Anti-Doping Agency (WADA) website, you can find their anti-doping code.  According to the comment to Article 4.3.2 of Version 3.0 of the World Anti-Doping Code (pg. 32-33):

A substance shall be considered for inclusion on the Prohibited List if the substance is a masking agent or meets two of the following three criteria:

  1. It has the potential to enhance or enhances sport performance;
  2. It represents a potential or actual health risk; or
  3. It is contrary to the spirit of sport. None of the three criteria alone is a sufficient basis for adding a substance to the Prohibited List. Using the potential to enhance performance as the sole criteria would include, for example, physical and mental training, red meat, carbohydrate loading and training at altitude. Risk of harm would include smoking.

Notice the WADA code specifically states that none of the three criteria is sufficient on its own for inclusion to the Prohibited List. That’s why red meat and carbohydrate loading, while they are considered to be performance-enhancing under criteria #1, are not on the Prohibited Substances list, because they do not represent a health risk to the athlete (at least not in the same way that recreational drugs would) and are not contrary to the spirit of the sport.

Altitude training, whose effects the CVAC pod is supposed to imitate, meets criteria #1 of performance-enhancing measures.  So if I were to treat those two as equal, then the CVAC pod device meets criteria #1.  WADA has already commented that the CVAC pod device, unlike altitude training on its own, is against the spirit of the sport.  So the CVAC pod device meets two of the three criteria for inclusion on the Prohibited List and should be on that list. Now, I’m sure there is more research that needs to be done on this device before WADA makes a ruling, but it seems if you put #1 and #3 together, use of this device should already have been prohibited by WADA.  From my understanding, the CVAC device is different from a basic oxygen tent because the pod increases barometric pressure on the person to more effectively deliver oxygen to the blood.

My guess as to why WADA hasn’t outlawed the CVAC pod device is that the device is not an actual substance that can be ingested or injected into the athlete’s body. You can ban drugs but can you ban an athlete from using a device? This is clearly new territory for WADA and they are treading cautiously. Note that as part of heightened efforts against blood doping, the International Olympic Committee has instituted a no-syringe policy for the 2012 Olympic Games. The no-syringe policy was already implemented by the Union Cycliste Internationale (UCI) in May 2011 this year.  But anyone who looks through the history of doping in sports knows that as soon as new anti-doping measures are adopted, more advanced techniques are soon found to skirt the rules.  Use of these devices is clearly new ground for anti-doping authorities.  Yet it seems like only a matter of time before WADA will have to confront matters related to ‘non-invasive’ techniques.

Also, in my argument for why the CVAC pod should be banned, I equated use of the CVAC pod device with altitude training.  Perhaps there is more research that needs to be done on this matter.  Does the CVAC pod really offer the same benefits as altitude training? Does it do more or less?  These are the types of questions that need to be examined.

Note that for blood doping, autologous blood doping (transfusing one’s own stored blood) is undetectable.  There is not yet an accredited test that can show that an athlete has received an illegal blood transfusion of his/her own blood.  Tests only exist for homologous blood doping (tranfusing someone else’s blood).  As you can imagine, homologous blood doping is nowhere near as prevalent as before.  So how do anti-doping authorities in cycling, a sport that’s had many high-profile doping cases, monitor autologous blood transfusions in the sport?

The UCI and WADA monitor the percentage of red blood cells (hematocrit level) in an athlete. The normal hematocrit level for an adult male is between 41-50.  The UCI sets the upper level at 50% for cyclists (anything above 50% is illegal and requires an immediate suspension). Even under these rules, there is room for athletes to continue blood doping (so long as their hematocrit level stays just below 50%).

Whether or not the CVAC pod device can increase an athlete’s hematocrit level to above 50% should play an important role in determining its legality.  So there is in fact a way (not a fool-proof way, but still effective) to test for unfair advantage through use of the CVAC pod device, by looking at the hematocrit level of the athlete. The same method that’s currently used to monitor blood doping in cycling.

Notice I have barely referenced the player whose use of the device garnered so much attention. I am not calling Djokovic a doper. From the available information, it’s clear that he has been acting in accordance with the WADA.  Since the WSJ article, more tennis players have been linked to using this device.  For the purposes of this blog post, that list does not concern me.  My post is an argument against WADA’s stance on the CVAC pod device.  I am questioning whether the rules should have allowed use of this device. There is a pretty clear distinction and I hope any/all readers can acknowledge that.

I think discussion of this issue is timely where tennis is concerned.  Tennis, not unfairly, has been accused of being too lax in its approach to athletes and drug-testing. As a cycling fan as well, I can only agree that tennis players are not placed under the microscope with as much frequency and scrutiny. Yet tennis athletes, compared to their cycling counterparts, earn more money on average at their tournaments.

Readers recall when Nadal started cramping during his press conference, following his R3 win at the 2011 US Open.  The news of his cramping incident first broke out over Twitter, as tennis fans tuned in to find out what was happening.  As a cycling fan, I was shocked to find Twitterers on my cycling feed commenting on Nadal’s incident and strongly implying that Nadal was experiencing a collapse from performance-enhancing drug use.  In the end, they were jumping to conclusions based on incomplete information, as anyone who saw Nadal’s press conference can see that it was a straightforward case of muscle cramps and not a collapse.  Quite unfairly, I think Nadal’s Spanish nationality had something to do with their accusations, as one of the most high-profile doping cases in cycling originated in Spain.

But the reaction to Nadal’s incident outside of the tennis world got me thinking.  How do the International Tennis Federation and the ATP/WTA’s anti-doping efforts compare to other sports?  Twitterers have pointed to the ITF’s anti-doping cartoon video, available for viewing on its website.  At first glance, it seems even the ITF seems to view their anti-doping program as a laughing matter, which is quite concerning.  Their perceived lack of gravitas in the face of a serious issue like doping, along with the focus that the CVAC pod has brought to a high-profile player, seem to indicate that the ITF, ATP, WTA, and WADA need a facelift in their approach to anti-doping in tennis.  If the greater public feels that tennis is not giving anti-doping the full treatment, they will feel free to insert their own narrative.  Too often, these narratives will be baseless and that’s due to the lack of complete information and the lack of stricter anti-doping controls in tennis.

If you’ve made it this far, I want to thank you for reading and would greatly appreciate your comments.  I hope I’ve done enough to raise the issues on this topic, but please feel leave comments if I’ve overlooked something or you want to share your opinions.

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About mariposaxprs

I play favorites with Juan Martin Del Potro, Rafael Nadal, Roger Federer, David Ferrer, Feliciano Lopez, Gilles Simon and the long line of mercurial talent that drives me to despair in front of the screen at odd hours during the week.
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38 Responses to The Egg Conundrum

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  8. Pingback: The Djokovic CVAC pod and the World Anti-Doping Code – FedererFan07

  9. kENNY JOHN says:

    STILL DON’T KNOW WHY USTA AND WADA HASN’T BEEN ALL OVER THE CVAC SYSTEM AND AND THEIR NEW HYPERBARIC POD CHAMBER – OR RED BLOOD CELL CHAMBER TO BE BLUNT ABOUT IT. WHY THE HELL ISN’T THIS THE NO. ONE TENNIS CONCERN. E.G. PLAYERS, COACHES, SPORTS COMMENTATORS, ETC. ARE THEY AFRAID TO TREAD THERE? OR ARE THEY AFRAID OF MAKING WAVES. THIS MACHINE IS “AGAINST THE SPIRIT OF THE SPORT” AND TENNIS IS TOO GREAT OF A SPORT FOR THIS TO HAPPEN. COME ON BODO, TIGNOR, MCGROGAN, BOLLETTIERI, AGASSI, SAMPRAS, WILLANDER, BORG, MCENROE, MARTINA NAVRATALOVA, ETC, ETC. OPEN YOUR MOUTHES AND START COMPLAINING ABOUT THE NEW RED BLOOD CELL ENHANCER. WHAT IN THE HELL IS THE MATTER WITH ALL OF YOU??? THE FIRST “GREAT PLAYER ON THE TOUR TO USE THIS MACHINE, OF COURSE, IS NONE OTHER THAN NOVAK DJOKOVIC. WHAT A GREAT VALUE SYSTEM THIS YOUNG MAN HAS. NO ONE HAS MENTIONED THE FACT THAT HE HAS NERVE JUST BY GOING THERE AND USING THIS MACHINE. HE DOESN’T CARE AT ALL WHETHER IT’S LEGAL, OR ILLEGAL (I KNOW THAT IT HAS’NT BEEN DECLARED ILLEGAL YET, BUT HE STILL HAS “BRASS ONES”. NO ONE IS GOING TO TELL ME THAT THIS MACHINE HASN’T INCREASED HIS ENERGY,STAMINA, AND ENDURANCE. THE REASON NO ONE IS DOING, OR SAYING ANYTHING TO FURTHER THE INVESTIGATION IS BECAUSE THEY’RE AFRAID OF MAKING “WAVES IN THE WATER”.IT’S POLITICS, JUST AS EVERYTHING ELSE IN THIS COUNTRY IS.

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  11. Pingback: Follow-up to the Egg Conundrum | mariposaxprs

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  13. Richard Foster says:

    Great article, but as a fellow cycling fan I think you’ve slightly oversimplified the point about Nadal being unfairly linked to doping allegations because “one of the most high-profile doping cases in cycling originated in Spain” – referring to Operation Puerto. It is well known that Dr Fuentes, at the centre of the Puerto affair, didn’t just work with cyclists. He himself is on record as saying he worked with football players, athletes and (yes) tennis players. It just so happens that cycling, which these days does more to tackle doping than any other sport, was the only sport that decisively investigated Puerto and took action. Other sports did little, if anything, to investigate involvement of their athletes. I have seen claims that the name “Nadal” was on one of Fuentes lists, but have seen no proof, and in any event have also seen claims that it was in reference to Rafa’s uncle, a football player.
    I’m not saying Rafa dopes, and I know you’re not either, but like cycling in the past, tennis has some black clouds in this respect that should be regarded as a tennis problem, not a “he’s Spanish and Spanish cyclists dope” problem.

  14. Stuart says:

    Excellent article. Very fair and views the problem from an objective stance. Seems to be a very contentious area. It is not a straight comparison with altitude training on whether it should be banned, and anybody who does is a fool. If your an athlete and you put in the hard work to gain the benefits of altitude training and your beaten by somebody who sits in this pod for 20mins a day is that fair?

    If the pod is proven to improve performance surely it will have to be banned. The theory of the pod sounds good but until some one independent can verify the pod delivers on the theory, I think its use is acceptable. It will become very dangerous to start banning placebos! It seems a lot of hype at the moment and very little hard evidence for or against.

    • mariposaxprs says:

      Thanks for your comment! It seems like the good folks at @Scienceofsport are looking more closely at the CVAC pod. They run a fantastic site, http://www.sportsscientists.com, and from their Twitter account it looks like they are now looking for the available research on whether the CVAC pod could affect performance. I only mentioned hematocrit levels as a testing measure in my blog post, but the issue could cover the biological passport profile as well. I’ll definitely be tuning into to see if there is any scientific research to back up the company’s claims (at the moment, there are only small studies about the CVAC pod that don’t measure their effect on performance)…

  15. Peter says:

    @ mariposaxprs are you on twitter?

  16. Joshua says:

    I happen to be opposed to “anti-doping” and all the hypocritical nonsense that accompanies it, so I wouldn’t mind if the ITF anti-doping regime was utterly ineffective. Unfortunately, it’s not. Yanina Wickmayer and Xavier Malisse faced a one year ban simply for not reporting their whereabouts. (In that case the ITF chose to enforce, against common sense and, in my view, fairness and legality, a decision by Belgian authorities.) Martina Hingis and Richard Gasquet have been banned for 2 years for cocaine (a drug which meets criterion 2, but not 1 or 3) which was detected at such low levels that if they were US Marines they’d have passed the drug test. Recently, Robert Kendrick got a 1 year ban for using an anti-jet-lag medicine that even the authorities agree a) had little effect on his performance and b) was ingested innocently. The ITF/WADA enforcement system is deranged, but it is certainly not ineffective or half-hearted.

    • mariposaxprs says:

      The Whereabouts system is controversial for the burden it imposes on the athlete to promptly report where he/she will be each day of the year. I admit I find the Malisse and Wickmayer cases unfortunate, as I don’t yet know of any reason to look suspiciously on their violating the whereabouts rules. Athletes in other sports have also spoken out against the harsh punishments meted out under an already strict system. Still, in my opinion, the rule is a necessary step in anti-doping efforts. This is where the ITF needs to step up their efforts to convey the message to tennis players that the whereabouts rule is a serious measure that needs to be approached with appropriate attention. Reading Wickmayer’s comments on her upcoming case, I felt she didn’t fully understand the severity of her breaking the whereabouts rule. I can’t help but feel that if the ITF had better conveyed why the Whereabouts Rule directive was a serious measure to combat anti-doping, that some of these reported violations would never have happened.

  17. Markk says:

    Homologous Blood Doping is detectable if a biopassport system is used where multiple tests are taken regularly over time and various blood factors are checked. At least if the doping is used enough to matter. It would change the age of certain blood components in an abrupt manner. The fact that only cycling does blood passport type screening probably shows how far behind other sports are.

    In regard to altitude tents I feel they should be allowed or you are just saying that you need to be wealthy enough to live at altitude and come down to train. Poor people or flatlanders need not apply. So really I feel those are levelers rather than enhancers. That says nothing about this device though.

    • mariposaxprs says:

      That’s a great point you made about cycling’s biological passport. Recently, swimming has adopted the same system as well. As for altitude tents, I think there is a lot we don’t know about the difference between altitude tents and the CVAC pod device. If I were to believe what the company says about the CVAC pod, the device is far more advanced than altitude tents. It’s time that a 3rd party stepped in and examined the specifics of this device and its effects on performance.

  18. Elena Gordon says:

    Kimi, if you read Djokovic’s comments over the course of the week (before the U.S. Open), he backtracked.

    How do we know which version of what he said is correct?

  19. Elena Gordon says:

    Ramesh, kindly read my post. The difference between high altitude training and the “egg” is…in the egg, the athlete is “passive”…not actually doing anything at all to improve his/her fitness. It’s all being done FOR the athlete. I believe that this is why WADA says that its use is “not in the spirit of sport”.

  20. Elena Gordon says:

    Mariposa, why was my comment deleted?

  21. Elena Gordon says:

    It seems clear to me that the use of the CVAC egg (or comparable contraptions) allows the athlete to have the benefit of super-high altitude training WITHOUT TRAINING. The athlete can sit in the egg and make cellphone calls or listen to music, etc.

    That is my guess as to why WADA says that its use is “not in the spirit of sport” (and not just tennis, by the way – they say “sport”).

  22. Kimi says:

    Why are you making such a fuss about Novak when he clearly said he was NOT using it this year at all? He tried it last year but he won’t change his routine this year which doesn’t include the pod at all. It became ridiculous to read all these “experts” and “analysis” trying to prove how Novak cheated but you are “not accusing” him of anything. At least have some honesty and admit you don’t like him and you’re jealous of his success.

    • “Notice I have barely referenced the player whose use of the device garnered so much attention. I am not calling Djokovic a doper”

      I don’t think she is making a fuss about Novak – as evidenced by this quote – as much as she is making a fuss about this contraption and its weird marketing. If anything, I’d say this post has been fair and balanced (take that Fox news 😉

      Are there people who are jealous of Novak’s success? Only as many as there are, who are jealous about Roger’s and Rafa’s success. I am a die-hard Federer fan, but despite what he’s had to endure at the hands of Novak and mostly Rafa, I am totally respectful of both of their achievements. I suspect the author of the post is as well.

  23. BRB says:

    Thank you for a timely and well-researched article. The distinction between ‘hyperbaric’ and ‘hypobaric’ chambers is confusing. Beats me why a manufacturer would want to tout this as twice as good as blood doping. The USTA and tennis pundits have brushed off inquiries about the effectiveness of this device. Please keep prodding. Many others want more information and a WADA study that is definitive.

  24. queridorafa says:

    Really interesting post with a great, balanced perspective. Kind of funny–I didn’t realize people were using Rafa’s unfortunate cramping incident as ammunition to make terrible accusations. I actually thought (and wrote about) my fear/suspicion of an almost complete opposite root cause–that he might be dealing with some sort of mono-like virus! (he’s been getting sick a lot this year). Anyway, my only other comment–I never quite understand when people say tennis is “lax” about testing for doping. In my opinion, tennis is maybe the most vigilant of all sports! The players must report their whereabouts for 1 hour every day of the year so they can be randomly tested (and they are–Andy Murray has spoken of being woken up at 7 am at his home during an off-week by drug testers). They are tested multiple times during tournaments, including right after the finals. How is this lax? This is so much more intense/strict than any other sport I can think of.

    • mariposaxprs says:

      Tennis follows the “whereabouts” rule instituted by WADA, where they have to report where they’ll be for 1 hour each day of the year. Track&field, cycling, and many other sports also follow the same rule. I find tennis to be lax in anti-doping b/c players aren’t subjected to as many drug tests as cyclists, for example. The ITF released information that showed that in all of 2010, there were 1,183 tests for male tennis players and 892 tests for female tennis players. Those numbers seem to be on the low side compared to other sports. On average, one cyclist will have 50 drug tests in a year. I don’t know how many different male tennis players were among the 1,183 tests, but those numbers probably don’t work out to more than 20 tests per year for the male tennis players. (http://www.itftennis.com/shared/medialibrary/pdf/original/IO_56345_original.PDF)

      Cycling and swimming have also adopted the “biological passport,” which closely monitors the blood profile of an athlete in order to look for biological markers that suggest doping. In truth, though it’s very difficult to find information about anti-doping in tennis, b/c the ITF doesn’t release too much data. But the info above is how I formed my impressions…

      • queridorafa says:

        Hmmm, well that does help me understand a bit–thanks for explaining! I guess I’m just thinking of sports like football, basketball, and baseball which I don’t think (in all honesty I don’t know…so I could be wrong!) have very strict testing systems. I’ve never heard LeBron James or Tom Brady talk about having their Saturday mornings interrupted by a drug tester at the door…I can’t imagine such a thing would be tolerated by athletes in their position (don’t know whether that’s good or bad, esp. given what happened today at the U.S. Open, where it became clear the players must figure out a way to better protect their interests). It’s a shame, though, that the system that is in place in tennis is both perceived as incredibly invasive by the players and, as you point out, inadequate by much of the sports public/press. It’s like the worst of both worlds!

  25. “Now why the CEO of CVAC systems would try to market the device as being twice as effective as blood doping, is beyond me” You have to wonder how big the problem (or market in this case) of blood doping is for him to actually market it this way.

    At the highest level of tennis, it often comes down to one or two big points that separate competitors, and if you are mentally and physically stronger than you opponent, more often than not you are going to win. I’m not suggesting that this is why Novak has leapfrogged his two big rivals, neither am I questioning his amazing run. I’m sure it has a lot to do with his diet, his dedication and drive to get there and stay there, but it sure is bound to raise eyebrows and questions, especially when they see him back pedaling on the issue.

    Maybe this machine does absolutely nothing, but like that placebo pill it makes you think/feel that your body won’t let you down at key moments? The mind is after all the most powerful organ in the world, capable of creating or destroying us. So, this might be nothing more than a couple of visits to the sports shrink? The problem however is that rabid fans of the afore mentioned big rivals are likely to start putting asterisks next to his wins if this is not explained.

    It’s a shame that people suspect Rafa of doping. These questions come from a place of complete insecurity and propagated by a few Rafa haters who want to see that Federer’s legacy is protected at any and all costs. If any of these guys are found to have participated in doping, as a tennis fan I would be devastated, but I am going to give all of them the benefit of the doubt… Innocent, until proven guilty!!

    Excellent post Janie. Looking forward to more insightful commentary 🙂

    • mariposaxprs says:

      “The problem however is that rabid fans of the afore mentioned big rivals are likely to start putting asterisks next to his wins if this is not explained.” That’s an excellent point, Ramesh. The extra scrutiny that Djokovic has received this past week is somewhat unfair, b/c it’s clear that WADA currently permits use of this device. It’s hard to tell just how effective this CVAC pod is, and as you said, it could be a complete placebo. More research needs to be done to separate the company’s PR from the actual utility of this device.

  26. Evie (@evietoo) says:

    It’s inconceivable to me that altitude training is not allowed. The pod I have more of a problem with, but training in the mountains or otherwise high altitude? That’s simply part of the natural world.

    New string and racquet technology is ok, but altitude training is not and people think this is reasonable?

    • mariposaxprs says:

      Hi @evietoo,

      Altitude training is allowed under the WADA rules. It’s considered performance-enhancing but it’s not harmful to the athlete’s health and it’s not against the spirit of the sport.

      I meant to say in the blog post that the CVAC pod mimics altitude training in its reported effects. The WADA considers the pod device to be against the spirit of the sport, whereas altitude training is not against the spirit of the sport. So altitude training is A-OK, whereas the pod device should not be (at least according to the rules).

    • Agreed. That makes zero sense. What if I was born in Denver, and trained there all my life? I have an unfair advantage for being born there? Yeah, Federer has an unfair advantage for being so ridiculously skilled too 😉

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