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    Lance Armstrong Absolved? EPO No Benefit In Cycling, Says Systematic Review
    By News Staff | December 6th 2012 03:30 AM | 20 comments | Print | E-mail | Track Comments

    Erythropoietin, called EPO, is banned from sports because of claims it can enhance an athlete's performance unfairly.

    A systematic review couldn't find any benefit but it found considerable risk of harm.

    Professional cycling remains a popular sport though its image has been tainted by high-profile doping cases. EPO, a blood-cell stimulating hormone, recently made headlines, when the self-appointed United States of America's Anti-Doping agency (USADA) claimed that it was used by record seven-time Tour de France winner Lance Armstrong. 


    If so, according to the systematic review, so what?  He got no benefit and no one would criticize him for wearing weird magnetic bracelets or homeopathy or eating organic food if he felt like it helped.  Normally, EPO is used to treat people with anemia, where its effect on each patient is carefully monitored. EPO thickens a person's blood, which can lead to an increased risk of clots. These clots obstruct blood flow to areas of tissue, and so oxygen doesn't get to the cells and they die, damaging the organ. If the organ is your heart or your brain this can be particularly dangerous, potentially resulting in heart attack or stroke. 

    "Athletes and their medical staff may believe EPO enhances performance, but there is no evidence that anyone performed good experiments to check if EPO would actually improve performance in elite cyclists," says lead researcher Professor Adam Cohen, who works at the Centre for Human Drug Research in Leiden, The Netherlands. Researchers work hard to prevent patients taking drugs that don't work or have dangerous side-effects.

    "So why should the standards be different for the same drugs used in athletes? Although doping is forbidden, the pressure to win in sport is so great that some athletes seem to be willing to try any way of getting ahead of their competitors. When elite athletes and their coaches discover that there is no evidence of benefit and clear risk of harm, I hope many may reconsider trying to cheat. Education may work where attempts at enforcement have failed," says Cohen. "I believe there is a clear need for high-quality research to investigate the effects of supposedly enhancing drugs in sport. If, as is expected, many substances in current use are found to be ineffective it will help keep our athletes safe and improve confidence in sporting results."

    Published in British Journal of Clinical Pharmacology


    Comments

    "when the self-appointed United States of America's Anti-Doping agency (USADA)..."

    "Self-appointed"? Where are you getting this bizarre notion? I'd think people interested in "science" would also be interested in "facts." The facts are USADA was appointed by the USOC, which has a congressional mandate. Its role was further codified as a result of the WADC and, still later, UNESCO convention (aka international treaty signed by congress).

    Hank
    The federal government conducted a two-year investigation and found nothing but a bureaucratic group that used no science and simply relied on anecdotes is accurate?  The USADA had zero authority to strip him of Tour de France wins and your snippet eaves out that context. World Anti-Doping Agency president John Fahey agreed that the crackpot running USADA did not actually have any authority to strip anyone of anything so "self-appointed" was accurate.

    Even if he Armstrong it - and there is no evidence beyond 200 pages of anecdotes, which are actually not data - if EPO has no benefit, then it is nothing to try and ban someone over, any more than if someone sold him magic water.  You can't convict someone of jaywalking in America based on third-party hearsay and he passed hundreds of actual blood tests.

    If you care as much about cycling or athletics as your message implies, you should ask the USADA to show actual evidence and not rely on just-so stories.  They may be right, he may have been a huge EPO fiend who bounced back from cancer and that placebo made his feet move better than everyone else - but he either has to admit it or you have to prove it. 
    I don't totally disagree, Hank, but testimony is usually considered valid, and from what I have been reading, many many people saw Lance take "enhancers", and many many more heard him talk about it.

    So, in that way, it's evidence.

    In addition, there is clear evidence that he did test positive on at least one occasion, every party has admitted to that that was involved, including Lance, but Lance says it was from saddle cream while everyone else said it wasn't.

    So right off the bat, someone is lying if they claim that he didn't test positive, he definitely did.

    Lastly I would suggest that doping of one form or another has been systemic for years, unless we wnat to say that every pro rider that admitted it was lying to try to catch Lance. For instance, why would George Hincapie admit to doping, I seriously doubt anyone ever accused him, and all it does is ruin his legacy. Many others as well. Anquetil, Fignon, and others have admitted to doping.

    Do you really think that Lance came back from his illness to be a better cyclist than all the others who were using HGH, steroids, EPO, and blood boosting without using the same? History and testimony would suggest otherwise.

    Hank
    I just know that hearsay is not how legal decisions are made - and a whole bunch of hearsay would be easy to exploit.   You can't get together with 5 of your friends and say you saw me kill someone, for example - the police will expect a body or a murder weapon or something more than 'testimony'.

    The testimony against Armstrong are people who were cheats and disgruntled former employees, so that has to be factored in.  I am not surprised that people hate a fierce competitor nor would I deny he used every advantage he could.  But he is the only way that passed every test and so you would also require me to believe he is smarter than every other doctor in that field - and that last part is bordering on miraculous.
    This is literally like talking to my dad.

    Not every person that has said Lance cheated is disgruntled or has a reason to want to see him go down. And also, if you believe that everyone else used performance enhancers in that era, Lance's competitors, then you would have to say that not only was Lance not doping, but against all odds he dominated the Tour for many years fairly. I am not sure how that is explained. Maybe you don't think any of them doped, because so few got caught? And so Lance was actually riding among peers, not that they were all doped.

    I don't think it's hearsay when it's corroborated not only by many other people, but we can go and look at the actual races to see if there is agreement as well. And there is! In the beginning, I believed Lance becauswe he didn't test positive, but also I figured that LeMond was sharing his sour grapes. It never really made snese to me, nothing Lance said could make me respect what LeMond did any less, he was a great champion, so I don't really care, but why would Greg be upset? I don't get it. He was just trying to uncover what he saw, which correlated with the rise of doping in the early 90s.

    Bjarne Riis never even rode against Lance when he was winning, he was a domestique, but not a winner. He admitted using doping even though there wasn't really evidence that woudl have convicted him. So what does he have agtainst lance?

    It's pretty easy for defenders of lance to raise reasonable doubts, but the aggregation of evidence, correlating facts, admissions, and Lance's overall behavior toward former friends and team mates (all documented) shows that only one person is trying to deny it from that era, and that's Lance. Well, and you, Hank Campbell. I want to believe Lance, but this summer ended any way that I can defend him. I wish you would convince me, because Lance really inspired me.

    lisa, where are you getting this bizarre notion?; USADA self-appointed in the sense of assuming a high moral ground for the most of us, with our tax dollars; how about that statute of limitations of their own WADA, Art. 17, Code, that they broke; it only supposed to be done 8, not 14 years back; until you explain that you can't really talk about USADA legitimacy. IOC, as of late, also approached this matter of removing the bronze medal from 2000; they backed off, hit the wall; ohh, returned the ball to UCI, who supposed to remove the statute of limitations obstacle for them, but UCI ca't do that, so they're all hitting the wall.

    Sure that argument makes perfect sporting sense even if EPO didn't enhance performance.

    You can now get off your bicycle and let your brothers sister ride a few kilometers for you before getting back on because she rides slower than you and therefore it has no advantage.

    In soccer you can now handle the ball so long as the ball would not have resulted in going to an opposition player.

    In rugby you can now forward pass so long as the forward pass does not result in an unfair advantage for example deep in your own defense when there are no opposition players around.

    You could create this stupidity of an argument in every sport but ultimately they would all say the same thing sport is played to the rules.

    The rules of cycling are clear EPO is defined as a breach of the rules and advantage or not does not come into at that point if you used EPO you broke the sports rule and you are a disgrace to the sport.

    The only argument that is possible if what you have said is true is a case to have EPO removed from cycling banned list but until that time it is against the rules to use it period end of story.

    Hank
    I agree. Now if only someone would prove Lance Armstrong used EPO.  Hundreds of tests showed he did not and 0 showed he did - but lots of other people were busted for it when he supposedly was doing it, including people who then claimed he did it too. He may be a total fraud but ordinarily it would have to be proven.

    One cycling crackpot on a vendetta is not evidence.  In baseball, the MVP last year clearly tested positive and got off on a technicality. In cycling, a guy was convicted with no evidence because one guy insisted on it. Cycling is now less reputable, not more.
    I guess I would suggest you read some of the books that have come out since 1999, notably Tyler Hamilton's, Bjarne Riis's, and many more. They weren't caught because of a test, they were caught becasue they were found in books at the places where their "doctors" treated them, by code name. So Lance tested negative over 500 times. So did everyone else. Do you know anything about pro cycling, or are you interested in protecting Lance, or what? I don't disagree with you on principle, but you aren't convincing me that LAnce didn't dope. I read everything I could pertaining to this stuff, and it seems to me that you don't understand cycling, because if you don't know the sport, it's hard to understand how it all worked.

    In short Lance could pass thousands of tests and still be doping. It would help if you understood that.

    Also, just logically, if EPO doesn't help, that doesn't mean it's legal. In the early 1900s the organizers of the tour banned all kinds of substances and riders still used them, including booze and cigarettes. It doesn't matter if they actually enhance performance. From what I read, EPO was part of their routine, but blood packing seems to be more effective. Also mentioned were HGH, steroids, etc., so don't focus on EPO only. Tyler Hamilton, if I recall, wasn't caight for hematocrit violations but from a mix up with his blood and another rider's, he tested positive for "someone elses' blood in his body".

    "there is no evidence that anyone performed good experiments to check if EPO would actually improve performance in elite cyclists," says lead researcher Professor Adam Cohen".

    I believe him. No good experiments on "elite cyclists". But a quick google search shows that there's plenty scientific evidence that EPO enhances the performance of fit athletes. That should be enough to ban it from professional cycling.

    There's also evidence that Lance used EPO in 1999. His urine samples from '99 were tested again in 2005 (I think), with better methods, and these showed the presence of EPO. For formal reasons this evidence can't be used by anti-doping agencies, but the EPO was there.

    It's also curious that elite cyclists are climbing Tourmalet, Galibier, Ventoux etc. significantly slower since we have better tests to detect EPO. Perhaps another example of the placebo effect?

    Perhaps no undue weight should be given to the USADA report. Neither should undue weight be given to the opinion of mr. Cohen.

    Hank
    You're saying a professor in drug research is the same as a bureaucrat who gets paid to accuse people of cheating.  I don't think that is the case at all - science is not relative and there is a big difference between data and opinion.  The USADA had zero data.  None. The federal government searched for the mystery results you claim exist for two years and couldn't find them so it is unclear where you did.

    5 years from now people may not have broken Usain Bolt's record and he may run slower. Using your logic, he must be doing drugs right now because people won't be running as fast as him then.  In reality, humankind does not have the ability to march into the future without limit, or baseball pitchers would be throwing 120 MPH.

    Again, if the guy is a cheat, I will be first in line to make goat noises at him.  But a pedant on a committee who never accomplished anything except going after an actual athlete isn't credible because he relied on rumors and denied the actual test results.
    No, I'm saying that the guy who discovered EPO in the urine of Lance is just as much "a professor in drug research" as mr. Cohen - perhaps more so. How much does mr. Cohen know about the advanced detections techniques available now?

    I have to point out that your logic is far more flawed than mine. Perhaps there are no studies that show EPO enhances the performance of "elite cyclists". You jump to the conclusion that EPO doesn't work for elite cyclists like Lance. Are you suggesting that very heavy stones didn't fall to the earth before a scientific study proved they did? Although there was sufficient scientific evidence that normal, medium-sized stones did fall as expected?

    As I pointed out, there are studies that clearly show the performance-enhancing effect of EPO in normal, fit athletes. That's reason enough to ban it from professional cycling.

    I'm sorry, but your comparison with Bolt shows that you don't know cycling. We're not talking about individuel cyclistst here. Comparisons between the EPO-years and more recent times very strongly suggest that whole groups of cyclists in the TdF had a higher output than the best have now. Perhaps Bolt is a unique athlete, but whole groups of unique athletes? Where are these super-cyclists now?

    If you don't like USADA, fine. I don't care one way or the other. But the "actual test results" show that Lance used EPO. Only people who love conspiracy theories (those nasty French! Cheese-eating surrender monkeys! They hate Americans!) deny it.

    Hank
    If you don't like USADA, fine. I don't care one way or the other. But the "actual test results" show that Lance used EPO.
    Okay, where are they?  

    I guess I can let go the 'you don't know cycling' bit, because you've already claimed to have overturned all of physiology research with your previous comment.  But that logic is the same reason homeopathy people are duped out of money buying magic water - 'stupid science just can't understand'.
    "Okay, where are they?"

    Come on. Admit it. You don't know what you're writing about. You should have done more research about that positive test. Do it. It's a nice story, involving "a defense attorney defending high-profile athletes against doping charges" (quote the English language Wikipedia). You know, one of these high-powered lawyers you like so much in your other posts. He was appointed by the UCI. A very nice organisation, certainly if you like "self-appointed" agencies like USADA. UCI brings the expression "self-appointed" to new, previously unimaginable heights. Oh, and while you're researching - don't forget to google "uci armstrong donation".

    And no, I'm not overturning all of physiology research. As I pointed out, there's serious physiology research that indicates that EPO enhances performance very substantially in normal, fit athletes. That's not "stupid science", it's physiology research.

    I don't know where you got the "magic water" thing. Running out of arguments?

    If, for some general reasons, you don't like USADA - be my guest. I don't care one way or another.

    -PG

    It's a simple question, where are they? If you can't provide a simple hyperlink backing up your claims then stop wasting everyone's time. The fact that you are quoting directly from Wikipedia shows your lack of credibility. Don't reply with another windy 6 paragraph essay, all I want is a link.

    Joe_Walker,

    Hank doesn't like the USADA report. I don't think he read it.
    A good starting point are the pages 147-149. Do some research. But don't expect "simple links".

    I apologize for my windy essays. But it's all very funny, you know. Hank doesn't like USADA. He even believes there's no evidence that Lance took EPO. Now - and this is the fun part - in order to believe that L. never took EPO, Hank has to trust UCI - an organisation that's even shadier than USADA - and lawyers appointed by UCI.

    It's fun to be a contrarian, until you discover who your bedfellows are.

    Here again, you aren't understanding completely in my view. No one said that a specific rider's time slowed, EVERY RIDER'S TIME SLOWED. The average speed of the Tour has slowed to a time that correlates with times from before the 90s and early 2000s. Top riders, managers, writers and others have all agreed this is true, as well as there being facts, which you crave. I mean, to me, the fact that every major cycling participant at that level agrees that the times are on average slower is enough for me, but the times also show it.

    Secondly, humankind does improve over time, and I hope one day we see someone run faster than Usain bolt. But please show me evidence that would explain either the decrease of times before an accurate EPO test, then the subsequent increase back to the previous times after the test was put into play.

    Lastly, I don't know how you could hear from so many cyclists who were in the pro peleton from different times who could not care less about Lance, some of whom were dead before he was around, who say that doping is an issue in pro cycling. They can't all be trying to make Lance look guilty. Can they?

    "Athletes and their medical staff may believe EPO enhances performance, but there is no evidence that anyone performed good experiments to check if EPO would actually improve performance in elite cyclists," says lead researcher Professor Adam Cohen.

    There have been plenty of experiements conducted on elite cyclists - just ask Dr Ferrari. He had a raft of willing subjects on which to test the effect of EPO on sustained power outputs. The results were conclusive but publication wasn't a goal - the yardstick was race results. Payment was tied to winnings - if EPO worked well and the athlete placed Ferrari got paid - and he has been paid a LOT because his "patients" have enjoyed resounding success.

    Anyway, I hope Professor Cohen gets his grant - i am sure he will enjoy unertaking the studies and getting published.

    Hank
    I can't imagine Dutch granting agencies are falling over themselves to throw money at systematic reviews of EPO studies. And he already got published.  It isn't like he created one study with outlier results, the studies reviewed showed no benefit and possible harm. 

    If people were putting themselves at risk because it provides an advantage, I can sort of understand that. If everyone else gets ahead, you need to cheat to stay level.  But if the health risks are high and the benefit is nothing, it means snake oil salesmen are getting rich hurting people who think they are getting good advice.
    I am impressed by the content of this news. I don' t understand why this is called scientific blogging if there's no sign of science research in it. This content hits a low in the blog.
    About the topic, it is clear there'sno scientific evidence of epo good effects on professional cyclying, nor there ever will be, cause epo is forbidden, and a scientific research implies admitting the use of it. Altough , it is clear epo boost perfomance, allowing an overhall better oxigenation of the muscles. And this is scientific indeed.
    About the lance armstrong case, that is sad. Political cyclistic agencies with their economic interests and doctors and doping ruined one of the most beautiful sport. At first they protected their business, lance just like they did for pantani and so on, and then they cleaned their hands. But of course lance did epo, there's evidence, and many of his competitors as well, just he was probably one of the best organized doping cyclist, because of the money involved.
    He was also a champion, but would he have won so much in a fair competition? probably not enough to become a legend. Pantani was accused after just one tour, cause he wasnt enough protected, lance lasted till the end of his career. So what turned a champion into a legend? A good combination of doping and money and protection.
    But i don't accuse him, honestly if he wasn't into doping he wouldn't have won a single tour just some day run, cause it s not a fair competition, and to compete you have to start with similar possibility to recover energy on long events. So by the moment everyone does it, the better organized in doping and the better protected can win, but it is sad, because you can never know who is a champion, or how big a champion is