Apparently EPO Does Not Work!

[Merckx index]

I’m amazed that no one has pointed out the well known SoS analysis of a published study:

EPO improves performance by 54% in a laboratory trial

This great study, published in the European Journal of Applied Physiology earlier this year, evaluated the effects of EPO use on performance during cycling. We'll try to break the study down as simply and clearly as possible:

Who was tested?

They had 16 reasonably fit cyclists take part in the study. The pre-testing VO2max tests showed an average VO2 of about 3.90L/min and a Peak Power Output of 325 W. By no means world-class cyclists, but fit athletes. This does have some implications for the application of the data, which we'll get to later.

How were they tested?

The testing involved an 13-week period, where the 16 athletes were split into two groups. The control group received placebo injection, whereas the 8 cyclists in the EPO group received a dosage of EPO on a schedule worked out over the 13-week period. One potential problem with the study was that the EPO group could not be blinded that they were receiving EPO, for ethical reasons. What this means is that everyone receiving EPO KNEW that they were, and there's good reason to believe that simply knowing you're receiving a drug improves performance as well! The control subjects were blinded, so they did not know whether they were on EPO or not, which does partly offset this problem.

Measures of performance?

All the athletes were tested BEFORE and AFTER the injections doing two performance-trials:
• Peak Power Output testing - here, the subjects start off riding at a low power output and the workload increases every 90seconds until exhaustion. Basically, the cyclist has to go harder and harder until they cannot push anymore! The test is used to measure VO2max and also a Peak Power Output
• This was followed by a Trial to Exhaustion at 80% of the previously determined Peak Power Output. In this trial, the cyclist rides at ONE power output - 80% of their maximum, and they ride until exhaustion. This test is used as a measure of endurance performance. This trial was done after 4 weeks and again after 11 weeks of the trial.
The results: A 54% improvement in performance

We don't wish to go into all the blood analysis and DEXA work done - they measured all kinds of things, but this is a post about performance. And the main finding was that EPO use improved time to exhaustion by an enormous 54% within 4 weeks! Peak Power Output improved by 13% in the first four weeks of the trial. The graph below shows the results:


What are the implications?

The graph above clearly shows the benefits that can be gained through the use of EPO. At the intensity of cycling tested in this study, the improvement in time before exhaustion was roughly 11 minutes on a 22 minute trial. Of course, there are some (including us) who would debate the merits of a "ride to exhaustion" as a measure of performance. Normally, we prefer to see a Time-trial as a measure of performance, because the concept of riding to fatigue is not really an accurate or repeatable measure of performance.

However, when you consider the sport of cycling, the final climb of a big mountain day in the Tour is effectively just this - a ride to exhaustion. A group of riders will arrive at the bottom of a 10km climb together, and by the time they reach the summit, the winners are the ones who have managed to sustain a high power output without reaching exhaustion! Now, if you can improve your time to fatigue (that is, the point at which you crack and get dropped) by 11 minutes, that's clearly a massive improvement - it is the difference between making the summit and being dropped with 5km to go!

Another potential problem with the study is the extrapolation of the data to the elite. These subjects were fit, but clearly not elite. It's likely that in the elite, the improvement would be smaller. For example, you could hardly take an Alberto Contador, who might have a Peak Power Output of 500W and bump it up to 565 (13% increase, see graph above) in 4 weeks! Having said that, if you could take this figure and get it to 515W, that would be a very significant increase at the elite level. Similarly, if you could help an elite cyclist improve his average power output by only 5%, that would represent a major step forward. Whether or not EPO would do this is debatable, but given this study, it would seem that 5% is a pretty conservative guess for how much EPO would improve performance...

So can you win a cycling race clean?

So while the results still don't fully answer the question of "how much does EPO improve performance?", they do go a long way to showing us that the effect is potentially massive. Even a quarter of this improvement - 15%, would be the difference between a yellow jersey and the autobus during the Tour de France.

There is the slight problem that EPO is probably not the most widely used drug AT THE MOMENT - in the 1990's, certainly, its use was widespread, by admission and testing result. But in the current generation, it seems that more advanced chemical compounds, as well as blood doping are the choice of dopers. Is their effect the same? I'd lean towards saying, yes, they are, in which case you still have this potentially enormous increase in performance.

So can you win clean? As much as I'd like to think so, when you have this situation where a guy finishing in the top 10 is using drugs and being beaten by minutes on a mountain climb, I find it difficult to believe that physiologically, the margins can be that large. I believe that the NATURAL, physiological difference between riders is tiny - maybe 1% separates a champion from tenth place. So take a drug that improves performance by, let's be conservative and say 5%, and that mid-packer still can't win the race, then you have to wonder about the guy who is winning...?


This study clearly shows that EPO works. I'd extend that to say that any practice that increases the body's ability to carry O2 will work - so the same goes for blood doping. If they work, and work by the sort of margins we seem to be talking here - tens of percent, then can one gifted, unique individual dominate the sport? I think not.

This study did not analyze elite riders, which is why the article linked can make the claim that it has not been proven that EPO enhances performance in competitive cyclists.

But they go on to say this:

In any case, said the study, VO2 max is only a minor factor in the performance of endurance cyclists.
Only small segments of professional cycling races are cycled at such severe intensities that VO2 max is decisive. There are many other factors, none of them influenced by EPO.
They include the blood lactate threshold, which determines the point at which muscles tire; work economy, which is the efficiency of the metabolic system to convert energy into movement; increased cardiac volume; and the quantity of muscle mass available for sustained power production.

They don’t seem aware that mountain top finishes, which are usually critical in determining GT winners, are raced at severe intensities, where VO2 is decisive (as the previous poster notes). They also seem unaware that a critical factor in winning a stage race is recovery, for which again oxygen uptake is critical. Or that a lower blood lactate threshold can be offset by greater oxygen uptake.

As the previous poster noted, these researchers seem to have little familiarity with bike racing. I think they are just taking advantage of the fact that studies of PES are NEVER made on actual elite athletes--for obvious reasons--to argue that something that is unquestionably true has not been rigorously proven to be true. But if they were rigorously scientific, they would also do a statistical analysis on all the performances in the EPO/blood transfusion era, and compare them with performances in earlier eras.

 

[wannab]

didn't read it because I don't wanna waste time on it ...

plain simple, EPO works, NEXT!

 

[Tinman]

The only thing amazing about this story, including discussion here, is that it has become a story. Shame on those publishing it, retweeting it, etc, shame on those discussing the possible merits of it.

This type of BS sets back anti-doping and pro-cycling with the main stream public and uneducated cycling fans more than many realize.

 

[meat puppet]

This type of BS sets back anti-doping and pro-cycling with the main stream public and uneducated cycling fans more than many realize.

That was my first thought too.

Good thing that MI dug up the SoS article, I would have if s/he didnt. Things are really that simple.

 

[Dazed and Confused]

Hundreds of pro cyclist have wasted millions over the last two decades it seems. That gotta hurt a bit.

 

[meat puppet]

Hundreds of pro cyclist have wasted millions over the last two decades it seems. That gotta hurt a bit.

No wonder Ferrari et al. have moved on to providing help in tax planning, legal advice, accounting, and the like.

 

[doperhopper]

breaking news: EPO only works if you have less than two balls

 

[martinvickers]

The only thing amazing about this story, including discussion here, is that it has become a story. Shame on those publishing it, retweeting it, etc, shame on those discussing the possible merits of it.

This type of BS sets back anti-doping and pro-cycling with the main stream public and uneducated cycling fans more than many realize.

I disagree slightly - yes, it's utter, utter balderdash.

But it's good that it's public balderdash so that both peer and public review can cut it to shreds - otherwise, it pops up, unheralded in some doped riders defence brief, and no-one has had the chance to debunk it.

Ploughing through sh!t is part of the price of keeping any sport clean. Better we see the sh!t coming, because it will come anyway, and forewarned is forearmed

 

[Tinman]

I disagree slightly - yes, it's utter, utter balderdash.

But it's good that it's public balderdash so that both peer and public review can cut it to shreds - otherwise, it pops up, unheralded in some doped riders defence brief, and no-one has had the chance to debunk it.

Ploughing through sh!t is part of the price of keeping any sport clean. Better we see the sh!t coming, because it will come anyway, and forewarned is forearmed

Yes you are right conceptually but sadly things don't work that way. s**t sticks. As you also know very well. Your approach to posting here speaks to that (interpret that as you like, my inference regards your case for factuality in posts). But please do have the last word. Promise I won't reply to the next one.

 

[martinvickers]

Yes you are right conceptually but sadly things don't work that way. ..blah, blah, blah... But please do have the last word. Promise I won't reply to the next one.

I will be assured I may; and, that I may be assured,
I will bethink me.

 

[Alphabet]

I wonder what Tyler Hamilton would think of this.

 

[Aleajactaest]

Pot is illegal..again I can keep going but there really is no need.

.

Not anymore. And neither is alcohol. In small doses neither have significant effects.

I'm not going to email WADA since I guarantee that they won't tell me a damn thing.

 

[Aleajactaest]

I wonder what Tyler Hamilton would think of this.

LOL. That's a knee slapper. He is too busy enjoying his book award.

 

[Alphabet]

That's a bit cynical. Anyway my point was more about how he suffered during those first 1000 days as a pro, when him and all the other neo-pro's got hammered. He could prove through first-hand experience that EPO does work, and it's laughable to say that it doesn't/it had a placebo effect on riders.

 

[acoggan]

It should also be added that the study does appear to be written by people with a less-than-expert understanding of the dynamics of cycle racing.

Also a less-than-expert understanding of the physiology of exercise. To wit: other means of altering hematocrit/red cell mass have been demonstrating to impact physiological responses other than VO2max, including in elite athletes (e.g., http://www.ncbi.nlm.nih.gov/pubmed/3781999). It is therefore illogical to hypothesize that EPO would not do the same.

 

[Dear Wiggo]

If blood transfusions increase performance, it is through increased Hgb. EPO increases Hgb. Therefore EPO increases performance.

Also a less-than-expert understanding of the physiology of exercise. To wit: other means of altering hematocrit/red cell mass have been demonstrating to impact physiological responses other than VO2max, including in elite athletes (e.g., http://www.ncbi.nlm.nih.gov/pubmed/3781999). It is therefore illogical to hypothesize that EPO would not do the same.

Gee. Waddaya know.

 

[Athame]

Well OK, so EPO doesn't work but according to Lance Armstrong's Livestrong Foundation
(I know, I know) testosterone DOES work.

I just found this gem http://www.howlifeworks.com:

"Most people don't realize that testosterone is a vital hormone for maintaining
overall good health. An article from the Lance Armstrong Foundation's
Livestrong.com site, noted that testosterone stimulates the use of stored body
fat for energy and keeps you looking lean. It also helps in the battle against
cardiovascular disease, diabetes, osteoporosis, obesity, depression and
numerous other ailments."


__________________________ I think they forgot to add that it also helps you
win 7 TdF's, in a row *BEOTCH*

 

[The_Z_man]

I just saw the article this morning on Philly.com. I almost spit coffee out of my nose. I really can't add too much to what has already been said, excpet to say, it's bull.

 

[Pentacycle]

Of course EPO works, how could anyone deny that?

Some unknown 33-year-old Russian speed skater (Sergei Lisin) tested positive for EPO about a month ago when he won his national 10000 m championship, improving his personal best by 34 seconds. Just this recent example already proves that EPO is definitely performance enhancing.

 

[Dear Wiggo]

Of course EPO works, how could anyone deny that?

Some unknown 33-year-old Russian speed skater (Sergei Lisin) tested positive for EPO about a month ago when he won his national 10000 m championship, improving his personal best by 34 seconds. Just this recent example already proves that EPO is definitely performance enhancing.

It seems strange to me that cyclists stopped using EPO in 2006, and yet speed skaters are still using it for 15 minute efforts 6 years later...

 

[ustabe]

It seems strange to me that cyclists stopped using EPO in 2006, and yet speed skaters are still using it for 15 minute efforts 6 years later...

So 2006 is the cutoff year?

I have two words to refute the ineffectiveness of EPO: Bjarne Riis.

 

[Cavalier]

It seems strange to me that cyclists stopped using EPO in 2006, and yet speed skaters are still using it for 15 minute efforts 6 years later...

Bit of a baffling comment considering there's been a number of cycling EPO cases since then.

 

[Dear Wiggo]

So 2006 is the cutoff year?

I have two words to refute the ineffectiveness of EPO: Bjarne Riis.

Bit of a baffling comment considering there's been a number of cycling EPO cases since then.

Apologies. The was missing.

In his affidavit, Levi Leipheimer confessed to stopping EPO in 2006 - you know, after Lance was gone and no longer forcing injections into him. And then he did his best GT performances of his career.

A number of other affidavits mention the same or similar thing - I think JV stopped as early as 2000, but then admitted maybe he kept using his doping products up so as not to waste them, for the next 3 years, but only intermittently. Or something. ... On a clean team. Where they wouldn't let him inject cortisone for a bee sting in his eye.

Many posters here say doping is gone, or ineffective, as the BP prevents anyone from gaining any advantage over any cyclist as long as the EPO user does not warm down and the clean rider does. Marginal gains now nett a greater benefit than EPO enhanced Hgb. Apparently.

And here we have some speed skater not only using EPO, but doing a 34 second PB, over 10km, which I am guessing is 12-15 minutes on skates, so a massive PB. A nobody, apparently.

Personally, I think the cyclists have simply learnt how to circumvent the system and are doing so. Successfully.

 

[noddy69]

Apologies. The was missing.

In his affidavit, Levi Leipheimer confessed to stopping EPO in 2006 - you know, after Lance was gone and no longer forcing injections into him. And then he did his best GT performances of his career.

A number of other affidavits mention the same or similar thing - I think JV stopped as early as 2000, but then admitted maybe he kept using his doping products up so as not to waste them, for the next 3 years, but only intermittently. Or something. ... On a clean team. Where they wouldn't let him inject cortisone for a bee sting in his eye.

Many posters here say doping is gone, or ineffective, as the BP prevents anyone from gaining any advantage over any cyclist as long as the EPO user does not warm down and the clean rider does. Marginal gains now nett a greater benefit than EPO enhanced Hgb. Apparently.

And here we have some speed skater not only using EPO, but doing a 34 second PB, over 10km, which I am guessing is 12-15 minutes on skates, so a massive PB. A nobody, apparently.

Personally, I think the cyclists have simply learnt how to circumvent the system and are doing so. Successfully.

2006 is the cut off for what they have admitted, but that could leave them in a bit of a pickle. The fifth as people go on about is about not commenting on something if it will incriminate oneself. However immunity given they could spill all. However by suddenly stopping when lance left which it seems all these guys did doesnt that leave them in a pretty unfortunate position if it comes out that they have lied.
"Lance is gone so we all just stopped. We were all really nice guys who got bullied into it. We wouldnt do it ourselves.....not even entertain the idea now the beloved leader was gone that we might be able to grab a slice of glory ourselves, no no no we were not like that " how bloody ludicrous and when you look at the statements they were all written by the same guy.
Probably the same fella that headed up the "study" that didnt study anything saying epo doesnt work.

 

[BigBoat]

Well that proves it. All those cyclists from the early '90s through today took epo only for the placebo effect. That's gotta really upset the clean riders who dropped out of the sport.

Yeah....proof enough. Gives anywhere from 10-30% gain in sustainable wattage. The guy that went from "water carrier" to contender great example. The researcher doesn't act like he's tried epo. Try racing for a season clean, then raise the crit up past 50.