Erythropoietin
updated Feb 2005
Pharmacological cheating in sports is not a new phenomenon. Unfortunately, the modern era has witnessed explosive growth in new and different ways to achieve false victory. Advances in biochemistry, medicine, and other fields have benefited humanity in countless ways. Sadly, however, some have abused these advances for, “pursuit of victory at all cost”. A recent article by Dr. Timothy Noakes (1) highlights the breadth and depth of the problem. He discusses several “cheating venues”, but for this article I wish to focus on one, erythropoietin.


Erythropoietin (pronounced, ah-rith-ro-poy-tin, and abbreviated, EPO) is a relatively recent entry into the deceitful pursuit of glory. EPO is a protein hormone produced by the kidney. After being released into the blood stream it binds with receptors in the bone marrow, where it stimulates the production of red blood cells (erythrocytes). Medically, EPO is used to treat certain forms of anemia (e.g., due to chronic kidney failure). Logically, since EPO accelerates erythrocyte production it also increases oxygen carrying capacity. This fact did not long escape notice of the athletic community.

Blood doping is the process of artificially increasing the amount of red blood cells in the body in an attempt to improve athletic performance. In the past this was accomplished by transfusion. The athlete would “donate” a unit of blood into storage and then 3 weeks later, after the body had completely replaced the blood loss, transfuse the unit back into the body. This would occur just before a big race, effectively giving the athlete an “extra” unit of blood. This enables performance improvements in endurance sports because of the extra oxygen carrying capacity. The practice has been outlawed. Not just because it is unfair but because of the dangers involved.

EPO has put a whole new spin on blood doping. No need for messy transfusions, just shoot up with EPO to increase your circulating erythrocyte mass. Until recently accurate testing has been difficult because the recombinant human EPO made in the lab is virtually identical to the naturally occurring form and there are no firmly established normal ranges for EPO in the body. The only previously available route to curtail cheating for sports governing bodies was to ban an athlete if the hematocrit (see side bar) level was too high (e.g., above 50%). Thus, over the past 10 – 15 years some athletes chose to cheat because, as long as they kept their hematocrit levels below 50%, there seemed little risk of getting caught. Of course the other way to get caught was highlighted in the disastrous 1998 Tour de France. Several team doctors and personnel from several teams were caught red-handed with thousands of doses of EPO and other banned substances. Ultimately about 50% of the teams withdrew from the race – either for cheating or in protest.

Fortunately, testing technology has now caught up and promises to stem the tide of abuse. There is now an accurate urine test that can detect the differences between normal and synthetic EPO. This test is now the standard and was the sole means to detect for EPO use in the 2004 Athens Olympic Games. The reliability of this test helps explain the cascade of athletes who have been caught and, subsequently, banned from competition. This surge in positive tests will likely decline as the “word” gets out and EPO use declines -- at least until someone figures out a work-around. Of course, there is always the next great pharmacologic or genetic cheat just lurking around the corner to consider.

Ref(1) – Tainted Glory – Doping and Athletic Performance. Noakes, TD. NEJM. 351:9. Aug.26. 2004

Why is EPO dangerous?
The reason that EPO, and transfusion blood doping, is dangerous is because of increased blood viscosity. Basically, whole blood consists of red blood cells and plasma (water, proteins, etc.). The percentage of whole blood that is occupied by the red blood cells is referred to as, the hematocrit. A low hematocrit means dilute (thin) blood, and a high hematocrit mean concentrated (thick) blood. Above a certain hematocrit level whole blood can sludge and clog capillaries. If this happens in the brain it results in a stroke. In the heart, a heart attack. Unfortunately, this has happened to several elite athletes who have used EPO.

EPO use is especially dangerous to athletes who exercise over prolonged periods. A well-conditioned endurance athlete is more dehydration resistant than a sedentary individual. The body accomplishes this by several methods, but one key component is to “hold on” to more water at rest. Circulating whole blood is one location in which this occurs and, thus, can function as a water reservoir. During demanding exercise, as fluid losses mount, water is shifted out of the blood stream (hematocrit rises). If one is already starting with an artificially elevated hematocrit then you can begin to see the problem -- it is a short trip to the critical “sludge zone”.

Additional dangers of EPO include sudden death during sleep, which has killed approximately 18 pro cyclists in the past fifteen years, and the development of antibodies directed against EPO. In this later circumstance the individual develops anemia as a result of the body’s reaction against repeated EPO injections.

Well, if those opponents were anything like the mess of third-string baseballers getting caught with steroids, maybe it's not such a stretch...

From what I read and hear, the science behind this test has already been disproved and discredited. Just some "investigative reporter" wants to make a big name for himself by spooling together some bullshit.

Oh and by the way, in '99 so what if he tests positive for EPO? ITS A WIDELY USED TREATMENT FOR CANCER PATIENTS ASSHOLES. Do you really think the supposed "gains" of EPO overmatch the debiltiating effects of brain and testicular cancer have on the human body? get a fucking clue.

FUCKING Frogs, this story seems to want to set aside the hundreds of tests he passed since this so called failed test. Yeah that EPO in '99 really helped him in the mountain stages this year....Its ok though, the French just being the bunch of whining little bitches that they are.

The guy brought more media sponsorship to the event in record numbers than ever before, and the head of the TDF rails on him too. LOL. what a buncha sore losers. its not like FRANCE hasnt ever LOST ANYTHING BEFORE.

I didn't have to time to read all, so my apologies up front. This case is different. Armstrong has tested clean since then yet still walked away with the Tour 6 other times. This is incredible proof that he didn't need (or they wouldn't have made a competitive difference) in 1999. The same cannot be said about other sports stars, who are proven through tests to be off the juice, etc. but keep up their performance levels.

1- I believe that Armstrong doped himself to win the Tour.

2- I believe that all the big cyclist has doped (at least in the last 20 years) including Indurain.

3. I believe that if the name of Lance Armstrong was instead Lance DePuy this article has been never published.

You'll find that most americans

1. Believe Lance at some point in his career took something illegal

You'll also find that most americans

1. Don't give a flying fig about it


However.. this does seem kinda bitterish and poorly timed.. would be like a brazil newspaper printing a article now saying barthez and zidane were bulking up on roids during their world cup winning year

Well that's pretty sad commentary on the French, just strengthens those stereo types. This is the magazine that wrote this about Lance and the tour before this "scandal" broke. From a AP article.


Sorry, I don't see ESPN acting like that.

That assumes that testing clean means a guy is clean. In fact, we know that the cheaters are always two or three steps ahead of the testers. Masking agents, untraceable drugs, designer steroids, etc., make it relatively easy for a motivated cheater to avoid detection. It usually takes a mistake by the cheat to get caught -- Balco was the exception because the testers got tipped off and were able to test for it before the cheaters knew they could.

All the top sprinters in the 80s tested clean over and over again. Ben Johnson tested clean plenty of times before Seoul, but he admitted he was juiced the whole time. Linford Christie tested cleans hundreds of times before he finally failed a test. Marion Jones has still never failed a test despite an almost ridiculous amount of evidence that she was a fraud. Virtually all elite-level cheaters will test cleans the overwhelming majority of the time -- it's just a question of whether they do eventually get busted or not.

And yes, I realize this puts clean atheletes in an impossible situation because they have no way to prove that they're clean. That's unfair, but it's the reality.

What a crock of shit.

French Maids rock the house. Nice job, Pierre.*






* Ripped off from beer commercial

"It's hard to respect the French when you have to bail them out of two big ones in one century. But we have to hand it to them on mayonnaise. Nice job, Pierre."

I know I said I was out, but just for info purposes:

Drudge top headline: TOUR CHIEF: ARMSTRONG 'FOOLED' WORLD

We were duped!

you left out the most important part: developing...

:D

Summary:

Is it likely that Armstrong was on EPO, which enhanced performance, but could not be tested for in 1999, used EPO during the 1999 TdF? Yes.

Is it likely that this gave him a competitive advantage? No (because if there is a performance enhancing substance that cannot be tested for, EVERY cyclist is on it, guaranteed).

Is there any chance that this test, on a urine sample stored for 6 years in a country where every single one of its citizens wants the provider of said sample to have used drugs, is legitimate? No.

This is all of France now ? Idiotic slurs don't make an arguement.

Which is worse:

A) Lance Armstrong being falsely accused by a magazine for doping

or

B) Immoderately slurring an entire nation of people--many of whom probably are profoundly uninterested in Lance Armstrong's travails--based on the actions of a relatively minute amount of loud accusers?

---

I mean, really. Regardless of whether Armstrong did or didn't dope, all this nationalist B.S. is idiocy of the highest order. Perhaps y'all should begin campaigning to send the Statue of Liberty back home next.

I'd like to know who the other 14 riders that tested positive were.

You seem to be making the faulty assumption that the disdain is being generated in a vacuum of some sort, that what you're referring to is just about Lance & this article.

That would be, as I'm sure you know, a baaaaaad assumption.

No, I'm fully aware of the context for the anti-France sentiment around here (and elsewhere). It's still idiotic to paint everyone in a country by the same brush.

Not when the odds appear to be in favor of painting with the right color, then it's a simple matter of practicality.

Trying to do an individual analysis of every resident of most any nation seems like more of a fool's errand to me ... especially since 99.9999% of them are incredibly irrelevant to your entire life in any way. The fractional percent that actually matter? Fine, assess them on an individual basis, but beyond that it seems to be a major waste of time & energy.

An individual analysis is unnecessary...but an acknowledgment that the political and cultural positions taken by even a large majority in a country probably do not represent the views of everyone in that nation is very necessary. Being French doesn't suddenly make one hate American bike riders and military conflicts, despite the current anti-French party line. Nor does being American suddenly make one a gun-carrying war-monger, which tends to be the perception overseas.

dola...

The danger of such nationalist rhetoric, of course, is that it eliminates the possibility of trying to understand where other folks are coming from, and thus eliminates the possibility of any outcome but a violent confrontation.

NM, do you really believe that any substantial number of people don't/wouldn't acknowledge that there are exceptions to most general rules? (where general characteristics are concered I mean, because right/wrong behaviors is a whole diff. subject).

Hell NM, I'm probably among the most consistently hard-line people you know, but I'd be pretty surprised if you said you didn't believe that I make that sort of allowance.

It doesn't have to be spelled out in great detail in every conversation or situation in order to exist.

You say that like it's a bad thing ;)

i personally don't think Lance Armstrong did any drugs to win the tours. the French aren't good at riding bikes, they should just leave it at that.

If this bizarre version of ESPN, which essentially runs the Tour and has a long-standing open dislike of Armstrong, is the only source of proof of this accusation, it sounds remarkably like Dan Rather and the infamous documents that led to the downfall of CBS News.

I understand why they're doing it. Probably, Armstrong's dominance has led to an overall lowering of popularity for the Tour de France. Most people still don't care about it in America, and it has to be frustrating to many French people that their race has been dominated by an American.

But the accusation is suspect. That's what happens when you allow your organization to take sides like that.

In most cases? Until their beliefs are challenged in some way, yes, many folks are comfortable believing and saying plenty of nationalist/racist/sexist rhetoric. I was shocked when people took that "Freedom Fries" garbage seriously (our minor-league ballpark--affiliated with the Yankees now, natch) still serves them. Not to much of an exception there.

I would hope that was the case, but I've seen little evidence of such allowance from most folks who behave in those ways. While every conversation doesn't need it spelled out, "FUCKING Frogs" doesn't belong in any of them.

And your "garbage" is actually one of my more favorite moments of the past decade. It illustrated the collective disdain of a collective group.


I disagree wholeheartedly, in so long as it's use matches its intent.

And I'll even go so far as to offer a possible test for the use of
"Fuck {insert target group here}"

If you mean that you would accept the loss of the good whatevers in order to rid the your life/the world of the bad whatevers, then I believe the phrase is well-chosen.

Disagree with it all you want, but I don't think it's an unreasonable test (for the use of the phrase). With the exception of generally obvious flippant usage, if you hear me say "Fuck so-and-so", that's a good sign that I've at least subconsciously applied that very guideline.

Now, as long as you don't ask me whether I believe a majority of usages are actually thought through that far, I should be pretty much good-to-go here.
:)

I will be visiting France in a couple of years. I'm going to Paris on one trip for my 10th annivesary. And to the Normandy Beaches on another to see where so many Americans and British died 60 years ago.

I'll report back if the stereotype of French people being mean based on nationalistic values is true or not. :)

So "fucking ignorant jackbooted rednecks named Jon in Middle GA" is ok then?

:p

I believe you have just defined "obviously flippant usage"*

*Note the correct use of quotation marks to indicate an actual quote.

Gracias.

LOUD NOISES!!!!!!!!

If you mean it I really don't see a problem with you saying it, you fucking worthless posterchild for the use of retroactive abortion.

Ya, but then your Mom couldn't have had you.

Son!

:D

I base my opinion of the French through the interactions i have had with them. Each time they are snotty, lazy and a buncha pussies. In several Joint Training Operations, I came away with the opinion that the only French unit worth a shit was the FFL. Wonder why? Oh yeah, half the unit isnt French at all!

Well, basing my opinion of you on my interaction I'm having with you currently, I think you're an arrogant and ignorant asshole.

actually FFF, if you use his logic, based on the interaction you're having with him, you should conclude that all residents of his nation (USA in this case) are arrogant and ignorant assholes... :rolleyes:

FM

Agreed, i think its possible to make a good arguement, and defend your beliefs without making racist comments

Getting back on topic here...from Yahoo News, at http://news.yahoo.com/s/ap/20050825/...AwBHNlYwM3NTU-



/tk

I lived in Belgium for three years. I worked with many French people. I visited France many times in those three years (as one of the best parts of Brussels is that it's only 1 hour and 20 minutes by train from Paris). During my three years I found some French people to be very cool. I made some good friends. I found some French people to be assholes.

I have lived in America for the other 28 years of my life. During those 28 years I have found some American people to be very cool. I made some good friends. I have found some American people to be assholes.

The results are shocking.

I stand firm in my long held belief that Lance Armstrong did not, and has never, taken performance enhancing drugs. This is a witch hunt. This is crap. Lance rules. The rest of those bike riding people suck.

I know one French guy, I used to work with him. Very cool, very smart guy.

But he wasn't rooting for Armstrong's failure like the majority of French do. That alone just speaks volumes about them.

I'm with you, HB.
Then again, I think my posts have been hidden by the other stuff going on here. Read my views at the blog.

/tk

Interesting article, which clarifies two important things that help us to understand the story:

- Armstrong strongly denies having EPO in his sample, period. He is not using the cancer treatment defense, he says the drug wasn't in his system at all.

- Improper storage of the samples would not cause a false positive for EPO. They could cause a false-negative because the traces could disappear, but not a positive. So if there's EPO in the sampe now, it's either because it was there in the original sample or because the sample was tampered with.

It does? How so? This is sports. What does rooting against the "other team" say about you other than you're a fan of "your team"? I don't get it. I am a Lions fan. I actively root for the failure of the Packers, Bears, Vikings, amongst many other a NFL franchise. What volumes does that speak about me other than "I am a Lions fan who would like to see my team succeed and the teams my team has to compete again fail"?

I still can't figure out why this is even an issue. So what if he did take something. Sorry but doping in cycling just doesn't matter to anyone not French. Or not bored.


*Of course I could give a shit that Armstrong won 7 Tours de Frances in the first place. I'm not gaga over it like the rest of the free world.

Lance's claim is that the science behind the test is faulty, so you can't even trust that there really IS EPO in the sample.

But the independent experts in the article seem to refute that. Or at least, they refute the specific idea that the six year delay could have caused EPO to somehow appear (or to trigger a false positive).

If Armstrong is referring to something else, then he may have a case, but he needs to spell it out in more detail than just saying "faulty science" and leaving it at that.