Bad Message

Saw on the big ultra list today that Leadville 100 is offering prepaid IV recovery fluids to runners for $75 and an additional bag for $100.

From https://leadville100.10ksportmed.com/Page/Details/2
leadvilleiv

IV Fluids
Intravenous fluid supplementation enhanced volume restoration of your blood stream. In addition to sodium and chloride, dextrose (a sugar substance) is delivered directly where it is needed most (to your blood), bypassing the stomach pathway. Many athletes recover quickly using this approach.

Is this what our sport is coming to?  Granted, a year or so ago, the longtime Leadville RDs sold their races to a big company called Lifetime Fitness, so the commercialization, while perhaps a little unsettling, should probably not be surprising.  However, the fact that they are encouraging IV use for recovery is very bad in my humble opinion.  If you run yourself to the point that you need IV fluids for recovery you have screwed up.  Similar to a high CPK value, this is not something to be proud of or celebrated.   I am not suggesting that a race having IV fluids available at the finish is a bad thing.  In fact, I think it is good and I’ve seen many runners helped by receiving them.  But, pre-planning that you’re going to need them is ridiculous.  This is so anti-Haggin Cup.  Seems like such a bad message to be sending to new people in our sport.  As Rachel Maddow would say, I need someone to talk me down.

7/28/11 2pm PDT update:  The option to purchase pre-paid IV has been removed from their website.

46 Comments

  1. 1. Benefit of the Doubt: perhaps they’re trying to “cut medical costs” by charging for those services — announcing they will charge you for fluids, then being “nice enough” to allow you to pre-pay (as if it’s insurance??).

    2. A Bad Omen for the Future. This has been a “to-do blog post” for me: with the huge up-tick in, A.) people running ultras, and B.) people trying to run FAST instead of simply run…I think it’s only a matter of time before we see publicized cases of permanent physical harm or death due to running too hard. The story of Diana Finkel at HR 2010 should be a tremendous “wake-up call” for what can happen if you push too hard. But it doesn’t seem to me like many took notice.

    It’s weak to DNF if you’re “not gonna win”; but on the other end, a major downer to your fellow racers if you keel over and die – and perhaps the race (or sport) along with you.

  2. OOJ –

    1.) It’s a clear cut case of trying to make a buck with the new ownership of Lifetime Fitness. (And a change in the Medical Directors too; I’m friends with the previous one.) And, it has nothing to do with “cutting medical costs”, since a bag of saline doesn’t cost the $75/$100 they are charging. RD’s factor IV bags/fluids/services for the people who actually NEED them into their race budgets. (I’m the RD for The Bear Chase 50.)

    2.) Diana Finkel wound up in the hospital with renal failure not just by running too hard at Hardrock, but also because she took Ibuprofen (a HUGE no-no).

    And it’s not “weak” to take a DNF – If you’ve never had one, it just means you’re a.) lucky or b.) you haven’t pushed yourself hard enough yet.

    Peace!

    • Mr Edge-

      Thanks for the insight! The notion of “medical profiteering” always bothers me, and this example is no different.

      To clarify: “It’s weak to DNF **if you’re ‘not gonna win’**”. :)

  3. @ OOJ

    We’ve been having “wake up calls” for years. Diana Finkel and Erik Skaggs hospital visits were related to taking NSAIDS coupled with hard efforts. Google LB’s blog and read about Brian Morrison. If you feel the need to do a “Bad Omen” re-post, the more info the better. Certainly, though, make sure that the comparisons are made between folks who made training/racing mistakes and those who chose to push in pursuit of a fast time. Very, Very different discussions.

    I was disappointed to hear someone I respect bragging about his high CPK at States this year.

    I am disappointed in Leadville. “Hey don’t worry. If you didn’t do the training, didn’t respect the altitude or found yourself clapped out with dehydration, GOOD NEWS! The Leadville 100 has you covered! Because our event is for profit, your entry fee doesn’t cover any IV bags, so you had better pre-pay if you want any medical attention involving IV solution after the race. No dough, No Needle.” Don’t get left out!

    terrible.

  4. If you haven’t been watching Twitter this evening, there has been quite a banter on this subject. Not sure how one follows the discussion since there isn’t a hash tag… Twitter sucks for good discussions.

  5. I find this a super interesting topic of conversation but overall, I support it. Here is why in my opinion. No one is getting a competitive advantage from this, it is for recovery. Do you “need” an IV after a race? For most folks, probably not and you don’t have to buy one. You also don’t have to buy license plate holders, DVDs of the race, Logo’d polo shirts, or sweatshirts but you can buy them if you want as once again the race is making a profit. I personally wish I could have my race registration go down and not get a buckle after I already have one from a race. You certainly don’t have to buy the IV. You don’t have to take Ibuprofen during the runs either. These are all personal decisions that one can make or not make depending on what does or does not work for you. Yeah, its expensive to buy an IV at Leadville and they are making a profit from it, so don’t buy one if you don’t want one.
    But, if you want to talk about the fact that you didn’t do the training, then wouldn’t you say we shouldn’t have a bunch of “medical stops” during the race? Under that premise, you should know your own limits and not be forced to sit and eat to gain weight if you are the one in control of your own race.
    Now (to AJW’s point), if Leadville will not give you one if you medically NEED one after the race, well that would be ridiculous and horrible and I certainly hope that that is not the case. However, I don’t think its a crime for them to offer one if you want to purchase one for recovery.
    High CPK’s are no laughing matter and nothing to joke about for sure and I sure I hope that that is not what I am being linked to. I just think that if you want to purchase one for added recovery (not as a substitute for training or putting in the hard work), I don’t have a problem with that. I think taking Ibuprofen, etc is much more of a competitive advantage during the race (despite the fact that you are taking a huge risk) and deserves more emphasis than buying (or not buying) an IV at the end of a race. There is a lot of profiting going on at these races from the race fees to merchandise to soaring sponsorship money. Yes, the IV seems a little weird but in the end, I think okay.
    In the end, I think this is a great conversation.

    • Rod, I appreciate your position. I agree that all those things runners can purchase bring profit to the race (whether non-profit or not, they bring in dollars). But IVs are crossing the line for me, whether purchased or not. I can’t imagine standing up at the pre-race meeting at Waldo and telling runners that there will be food, a hat, a shirt, and IV fluids waiting for them at the finish. They are not in the same equivalence class. Post-race IVs are not something we *plan* to take. If not just for yourself, imagine what this looks like to a runner (and his/her family) new to 100s – and, remember, at Leadville, there is no requirement so anybody that pays the fee can run the race. They look at the registration and see that IV fluid replacement is an option. This is normal? This is expected? I’m gonna run myself into a state that I won’t be able to drink fluids and process them through my stomach when I finish? Is this really what this sport is about? Is this the direction we want to go? I might not care much if this were a fat ass with 30 people, but this is a huge race with lots of visibility. They can and will influence our sport. Now, if they want to charge folks for IVs post-race that is one thing, but encouraging it and making it available before needed is an entirely different thing.

      • That’s a compelling argument and I hear ya for sure.
        I’m just sort of for supply and demand. I actually have always found it sort of refreshing that Leadville makes no bones about the fact that it is a “for profit” race. I think the big field and “give it a try” mentality is pretty cool. No one has died out there and most who don’t have the experience have plucked down their money and given it their best shot and can say that they at least “tried” to run 100 miles within 30 hours. I kinda dig that. Don’t get me wrong, I love WS, but I feel like the money taken in there is a bit more veiled. Like the “$200″ buckle and that it costs more than the $400 to get each runner to the finish line. I don’t know, I just like the transparency of the Leadville race in that regard.
        Maybe the IV’s will catch on, maybe that won’t. I agree that the message shouldn’t be that it is “encouraged” as I think it would be better sold as “insurance”. I don’t know. I don’t personally think it hurts the integrity of the sport. Running 100 miles is hard and that simply is not going to change. And, ultimately, there is a wide array of 100 mile races that will cater to different people and the amenities that they want from the race. WS definitely is “too much” for some folks who don’t want all that hype and thankfully they can choose a race that is more of a true wilderness experience if that is what they are looking for.
        I think in general, public demand will weed out what is needed and wanted and what is not.

  6. So a follow up:

    I sent an email 10K Sports Medicine. I got a quick response. The IV’s they are offering are a separate package from the Medical that will be working the race and are intended for Recovery. Medical will still be providing assistance on a “need basis” as determined by the staff that is working.

    I guess it’s come to that. I know when Lance dehydrated in a time trial one year at the tour de france they gave him two bags of saline afterwards so he could recover and minimize the damage.

    My comment about the No Money, No Needle. Off the cuff, but I enjoyed writing it.

    MonkeyBoy

    • Thanks for clarifying. Not that it makes any sense at all, but at least they will help those that need it at the finish. I do hope they come here, read this post and subsequent comments, and comment on this themselves.

      • I was glad to get the reply and clarification.

        That said, I still don’t like to see it advertised along with your race schwag. It might make people think that this is something that they NEED. Should Leadville runners be empowered to instruct a volunteer to bring them and install their pre-payed recovery IV after a 100 mile run? Does purchasing this set up an “expectation” in the mind of the runner related to recovery, or post race pain relief? What about the Psychological component?

        “I need my (blank) in order to properly recover from this”
        1. Food/Recovery Drink
        2. Compression
        3. Massage
        4. Beer
        5. IV

        I would like to think that most runners would take pride in knowing that they could finish a 100 mile run over the weekend and still be functional on Monday for family and work without the assistance of IV fluids or NSAIDS. My opinion.

  7. IV’s aside, I feel that the races I’ve experienced are primarily focussed on runner nutrition, weight and medical care on course while post-race health and recovery is overlooked.

    If you finished, you must be OK. Right? Hmm…

    • Jim, you must not have run WS, as there is a lot of post-race care. This year (and most years) they had free blood and urine tests at the finish line for kidney function, sodium levels, CPK, etc. They also take your blood pressure, pulse, and weight. If they notice a problem they would let you know and take appropriate action. And, the next morning at the awards ceremony they read off names of runners who need to see the medical folks. Finally, the days after the race they follow-up on any runners who had issues (unfortunately I know about this because I’ve had several friends who have been admitted to the hospital). We also try to take care of runners at Waldo post-race but don’t have the resources yet to do all the testing that WS does. So, some races do take post-race health seriously.

      • Hey Craig,
        Indeed, I have not run Western States or Waldo. This is very encouraging news. Having just completed my first hundred in Vermont, I am not ashamed to admit that I could have used some simple guidance at the finish. Thanks for this thoughtful blog.
        Jim

  8. Other revenue ideas for ultras:
    1. Don’t have a pacer? $50 and we’ll get you one. Extra $25 and they mule stuff for you. Extra $50 and they’ll carry a video camera and give you a dvd.
    2. $25 for upgraded aid station- we’ll fill your bottles and get you food while you sit. At regular aid you stand and it’s self serve.
    3. 5 minute aid station massage- $25.
    4. $10 and we’ll mention you at the pre-race meeting.
    5. Need crew? That’ll be $100 please, but they’ll pretend like they actually know you. Extra $50 and they’ll wear custom t-shirts that you provide.
    6. Bottle of recovery drink at finish- $5, but it’ll be cold.
    7. $2 to drape a blanket over you to ward off the chills.
    8. $50 and we’ll create something to specially recognize you, that you can display at the home or office. “why yes, I did win my age group for all runners from the state of Oklahoma!”
    9. $10 and we’ll clean you up at the last aid station so you look good at the finish.

    Prepay online- website provider takes a 5% cut.

  9. yeah, can hardly wait until the first guy comes in to the finish with hyponatremia, self-medicates with the pre-paid IV, and goes into a coma. Gotta think this concept falls into the general category of “attractive nuisance” – call me old school, but seems like you shouldn’t take medication without the advice of a medical professional.

    • Interesting, TJ. So the race is attracting naive runners (“children”?) to use something that then harms them? That doesn’t say much for the runners ability to know that this could be dangerous. I would love to hear from the physician that is overseeing this. If not, maybe other doctors and/or lawyers will chime in.

      • My thoughts on the matter are that this couldn’t be a worse idea. Given that most of the available research (done at WS) points to about 50% of finishers being HYPOnatremic, the use of a standard normal saline or ringers lactate IV solution could be the very WRONG thing to do. Allowing someone with no medical training to self prescribe a medical therapy (and I wonder who’s license in covering this) is unconscionable. And even if they DO have medical training, it’s not appropriate to self prescribe in any case. I believe that the various medical profession boards in this state would find this troublesome too, if they knew about it.

  10. Craig,
    Interesting topic for sure but perhaps people are looking at this backwards, thinking perhaps organizations such as Lifetime and implementations such as a pre-paid IV offering to finishers are changing the sport. When actually the sport has already changed, and from the bottom up. Just like some runners out there calling for prize money at races (which is ok by me, btw) and RDs offering it in response to draw them, the end-users- ie runners- are calling the shots in terms of demand which forces supply. Runners are making demands with their race entry fees and blog posts about where they like to race and why. Perhaps this IV effort by Leadville, while an attempt at ROI no doubt for purchasing the race in the first place, is a mere gesture of catering to a new market. I wonder which race out there has the highest gross household income per runner? I bet WS, Leadville and maybe one or two others. Who is showing up to run? What are their needs/wants/expectations? How can we (as RDs, they must be saying) offer them a great experience- ie product- and make them want to come back. These are important questions that successful races (ultras or not) are finding answers to and runners are showing up (or not showing up) in response. If RDs aren’t asking themselves these questions they ought to. There is a lot of competition out there. And like the growing number of runners showing up to race, there is a growing number of races popping up to cater to them.
    In the end, I am not for or against offering pre-paid IV. To each their own. Personally, I won’t buy it this year at Leadville when I show up to race and “experience” what I think is a great “product”.

    • Neal, it wasn’t long ago that races regularly provided ibuprofen at aid stations. Not many do anymore but I imagine the demand is still there, as evidenced by several high-profile cases of ARF associated with vitamin-I. Sometimes races and/or RDs have to be better or smarter (perhaps to reduce their liability) than provide what runners demand. If this pre-paid IV is just a response to demand then maybe we as a community should talk about it like we are here. Perhaps we can influence (dampen?) that demand? This is the first ultra I’m aware of to provide this option. Do you know of any others that do this?

      Hope you have a great race (again) and enjoy your experience.

      • Hey Craig,

        I do not know of any [ultra] races that do this. But I find Andy’s comment enlightening. Maybe the practice is commonplace at big marathons, too? If not expected by some of the top runners? Maybe it is one of those in-the-know type things that isn’t widely talked about for fear of social repercussion- like this welcomed conversation, for instance. Geez… I sound like a conspiracy theorist.

        Thanks re: the race. It will be fun. They’re all fun, aren’t they? : )

  11. On a more serious note, I wonder what a permitting authority or insurance provider would think about something like this. As a person that’s had to go through a permit process, it’s one thing to say “we’re going to have a person that’s a nurse or trained in wilderness first aid, and if there’s a big issue then the local hospital is only 10 miles away,” and people are satisfied. It would be another to have to say, we’re offering pre-paid IVs, and so far we’ve had __ people prepay, and we’ll have someone there to do that.

    The county I’m in would completely flip out, whether it was being used as a recovery aid or not.

    And I wonder for an insurance provider whether giving an IV in the course of genuine medical need is the same risk-wise as giving one upon request, or pre-request? Maybe if it’s already being done, it’s not a big deal and is just accepted as something that goes along with insuring an ultra.

  12. This is interesting, and disturbing.

    First, a personal note. Back in 2005 at WS100 I finished 2nd. It was the race of a lifetime for me. Scott Jurek won that year completing his 7th consecutive victory. I went to find him after the race to shake his hand and he was sitting in the med tent getting an IV. I was pissed. Not because he didn’t deserve to win or not because he didn’t need the IV but something about it didn’t feel right. Turned out he asked for the IV to speed his recovery so he could run Badwater a couple weeks later.

    I also know a guy (in fact, one of the best Orthopedic Surgeons in the country, Steve Isono of Oakland, Ann Trason’s surgeon) who worked the finish line at Kona for years. He told me that the elite triathletes always got “poked” after the races to speed recovery. I always said to him that it would never fly to do that in ultrarunning as we don’t believe in all that artificial crap.

    Then, of course, there’s the late Dave Terry who always had an IV bag with him when he worked medical but seldom, if ever, gave it to runners. It was there for emergencies but the real recovery we needed to make was necessary beyond the bag. Always was, always will be. RIP Dr Dave.

    Sure, I’ve seen my fair share of IV’s (in fact, I received 38 litres after AC100 in 2004) and it’s my humble opinion that our sport should not go there. Maybe these guys in Leadville have a reason to do this but to me I don’t like it.

    Then again, I still eat solid food in 100’s!

  13. I posted this on the ultralist but thought I would share here. “Actually, they are graying the line of what is legal and illegal. You need a prescription for iv saline. This can only be ordered by a doctor.
    For a prescription to be legal a patient and doctor relationship must be established. It looks like to me you, the patient, is ordering the iv not the doctor which is illegal in my eyes.”

    and to further clarify:

    “I guess I should have used the term health care provider with prescriptive authority. One of the things that make a prescription legal is that there must be a health care provider/patient relationship. A prescription product (even IV fluids) must meet this criteria. In this case the health care provider is not ordering the IV the patient is. Something just doesn’t add up with this. I contacted the State Board of Pharmacy in Colorado and they said it wasn’t their jurisdiction. If it not their jurisdiction I would like to know who’s it is. I am trying to contact the FDA and am struggling with this route too. This is a PRESCRIPTION. Only a health care professional with prescriptive authority can order it. As I previously mentioned I am a licensed pharmacist in Kansas and Colorado.”

    • Greg, I am a pharmacist in Ohio, and I emailed the Colorado Medical and Pharmacy Board this am. I have not heard anything from them.

      I am so glad someone else realizes these are prescription products. If you can order an IV without a prescription, they might as well set up a Vicodin kiosk out there too!

  14. I just wrote a blog post on this also.

    I am concerned from the medical side of who is vetting these finishers and allowing them their pre-planned fluids. Like Kate mentioned, what if it’s the wrong decision? Whose liable now?

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