Did EPO use really kill some riders?

[Merckx index]

I stumbled across this while looking for something else. Interesting stuff. Don’t know if anyone has any better evidence for EPO-related deaths.

Abstract
In the wake of previous contributions by scholars like Verner Møller and Paul Dimeo, which have demonstrated the mythical nature of the accounts concerning two famous ‘doping deaths’ (the cyclists Arthur Linton and Knud Enemark Jensen), this article thoroughly examines the existing evidence (both anecdotal and scientific) concerning the much repeated claim that EPO ‘killed’ 18 Dutch and Belgian cyclists in the late 1980s and early 1990s. This examination shows that these claims almost absolutely lack empirical evidence, and that in fact the existing truly experimental and epidemiological research downplays or even rules out the existence of a casual link between EPO intake and sudden death in healthy adults. It is therefore concluded that EPO has been constructed by the expert literature and the lay press as the ‘drug of mass destruction’ of the war on drugs in sport, and that the story about the ‘EPO deaths’ is to be seen as anti-doping propaganda.

A search for journalistic texts reporting on these facts has been conducted using the LexisNexis database and accessing the online archives of some newspapers. Twenty-four news reports have been retrieved,35 in addition to a chapter from the journalistic book by Paul Kimmage. An analysis of these texts reveals an even higher degree of dispersion and imprecision. The number of victims range from ‘half a dozen’ to ‘around 40’ (other figures mentioned: 7, 14, 15, 16, 17, 18, 24 and 34). The most often quoted countries of origin are again Holland and Belgium, but Spain, Germany and Poland are also mentioned, with many texts simply referring to ‘European’ cyclists. And the time span can be as broad as 1970–1990, or as narrow as 1988–1990.

According to several sources, EPO began to circulate in Europe in 1987,48 when 3 of the victims recorded in Table 1 had already been retired for a long time. This reduces the number of potentially suspicious deaths to 14. The case of Bert Oosterbosch, who had retired in late 1988, the year before his death, should also be withdrawn from the list: if he had taken the drug during his professional career, its alleged deleterious effects would have faded long before his death.49 The list has now been reduced to 13. Four other victims died between October and February in the cycling off-season, when there was no point in charging up with such an expensive, cutting-edge drug.50 Of the remaining 9, 7 were amateur riders, who for the reasons just stated would be very unlikely consumers of the drug.51 This leaves the list with just 2 potentially suspicious riders: 1 low-profile young professional (only 23 when he died) and a cyclo-cross rider, neither of them the kind of usual suspect52 for such a hi-tech practice as EPO doping would have been at the time. These data therefore show little, if any, trace of the ‘about twenty world-class Dutch and Belgian cyclists’ killed by ‘rhEPO-induced erythrocytosis’.53 Of course, all this is not watertight scholarship, but at least it is based on some kind of empirical evidence and rational analysis. Perhaps the scientific literature can provide us with stronger counter-evidence concerning the claimed link between these deaths and EPO doping.

I have reviewed 35 academic texts referring to the alleged deleterious effects of EPO abuse: most of them are supportive of Eichner's contentions, in fact some of them citing Eichner himself as their original source.76 Of these articles/book chapters, 19 fail to provide empirical evidence or to quote any source for most or all of their claims concerning the fatal side-effects of EPO intake. Two of them77 just mention, as their only source, the statements or opinions, lacking empirical evidence, of anti-doping experts such as Eichner, Don Catlin and Robert O. Voy. Eight more articles refer some or all of their claims to other reports that either fail to quote a single source or piece of evidence, do not mention these side-effects, are based on literature reviews (not on original research) or quote some of the aforementioned experts. One article78 provides evidence for a sing le case of an elite cyclist in which thrombosis coincided with an intake of EPO and growth hormone. But the authors fail to provide proof of the causal link between the two, despite claiming that ‘the use of EPO to increase PCV [haematocrit] in athletes suffering from other predisposing factors to thrombosis … could lead to serious side effects’.79 So this leaves the list reduced to eight articles quoting original research and only six directly reporting original research conducted by the authors themselves, one of which is not based on actual experimentation but theoretical modellization.80

This article has shown that the story about the 18 Dutch and Belgian cyclists who allegedly died between 1987 and 1990 due to EPO abuse has no empirical basis. The available evidence rather suggests that this series of deaths has been artificially concocted and even inflated in absolute terms and, most importantly, that it is highly improbable that EPO had anything to do with these cases, principally because there is very little, if any, scientific evidence that EPO causes sudden death. It should therefore be considered more of a myth or an invention than a historical fact. A myth which in the last years has played a central role in the ‘scaremongering tactics’111 of the anti-doping campaigners, who until the early 1990s were rather short of casualties that might be attributed to doping ‘abuse’. In this sense, EPO could be labelled as the drug of mass destruction in the war on doping.

 

[Dear Wiggo]

IV EPO clears far faster than subcutaneous EPO.

Any idea if EPO delivery impacts on clearing %?

eg:

5000IU EPO IV clears in 6 hours. Not all of it is used - some is also passed in the urine. What %?

Is the % the same for subcutaneous?

I think this study says it is: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1873985/

 

[blackcat]

I have been saying this for some time, atleast on other non-cycling fora. It is much touted, but I always wanted more than anecdotal evidence.

I am the king of the apocyphal tale. It takes on to spot one.

Now, I am almost engaging in a logical fallacy myself, to assume that no evidence = did not happen, or equating anecdotal evidence =/= evidence

 

[rhubroma]

What incentive did the UCI have, then, to establish a 50% hematocrit rule if it did not feel EPO was behind the death of those cyclists in the late 80's early 90's?

 

[The Hitch]

Brilliant find there MI.

These themes of things being massively exaggerated, taken out of context, and accepted as truth without any real argumentation even, are very common in cycling and anti doping discourse.

Also this about EPO being made at times to sound as if it was the only drug in sport. Though, yes, of course it was the worst.

It is therefore concluded that EPO has been constructed by the expert literature and the lay press as the ‘drug of mass destruction’ of the war on drugs in sport,

 

[mewmewmew13]

Well you know what Ferrari said...

 

[Merckx index]

What incentive did the UCI have, then, to establish a 50% hematocrit rule if it did not feel EPO was behind the death of those cyclists in the late 80's early 90's?

Rube, I read about your horrific accident on a bike. Hope for a speedy recovery, and don't be afraid to take the PEDs for this. Is there going to be a lawsuit involved?

To your question, I think much of the rationale was an attempt to level the playing field, reduce the potential advantage riders could gain (though ironically, when everyone started taking it, the field was probably less level, as riders with low HTs were favored).

They may have also believed the stories of EPO deaths. I did, they sounded quite plausible to me at the time. It's only recently, when I have read of people, and animals, with natural HTs in the 60s, that I have wondered if the viscosity argument was overblown.

These themes of things being massively exaggerated, taken out of context, and accepted as truth without any real argumentation even, are very common in cycling and anti doping discourse.

The author also mentions Lyle Alzado as another myth.

 

[Escarabajo]

What incentive did the UCI have, then, to establish a 50% hematocrit rule if it did not feel EPO was behind the death of those cyclists in the late 80's early 90's?

I read somewhere in here that the true initiative came from a doping Doctor (don't remember which one) just because by looking at the tendency of doping He was afraid that some deaths were going to happened in the future. People were pushing the limits by going well over 60%. Stories about the hematocrits of some riders going into the hospitals being over the roof. So I guess it was safety of the riders one of the main reasons.

 

[DirtyWorks]

What incentive did the UCI have, then, to establish a 50% hematocrit rule if it did not feel EPO was behind the death of those cyclists in the late 80's early 90's?

I recall reading of Dutch under-23 heart attacks with not a peep from the UCI. As in, suddenly, for the first time ever in the history of the sport, young riders are dying of heart attacks and the cycling federation did nothing. It just so happens Hein Verbruggen was President of the Road commission going onto President of the UCI.

Part of the problem with his data is there was no on busting out the autopsy investigation budget to figure it out. Not that it was a heart attack of some kind, but figuring out exactly *how* the heart attack came to be. Which, would be the equivalent of a needle in a haystack at the time.

http://en.wikipedia.org/wiki/Erik_De_Vlaeminck (Roger's brother, one of the greatest cyclocrossers.)

De Vlaeminck's son Geert died of a heart attack in a cyclo-cross race while his father was watching.

EPO? The researcher would treat that as no evidence of EPO abuse. I really don't know either way. But, right time, right place, right family. Patrice Bar is another one to examine.

Forum member Esafosfina was a Pro during the era and contributed the opinion that no one "knew." I agree. But, I'm just some anonymous joker.

Also check this thread for a similar discussion. I've still got a list of deceased elite riders from the era that I never finished filling out. http://forum.cyclingnews.com/showthread.php?t=9589

 

[RobbieCanuck]

I stumbled across this while looking for something else. Interesting stuff. Don’t know if anyone has any better evidence for EPO-related deaths.

Here is the problem with your analysis. It focuses on whether or not EPO was the direct cause of the deaths of an unascertainable sample of cyclists. The ONLY way to know this is to obtain the autopsy reports of each and every rider for whom it is claimed or is suspected of dying due to the effects of EPO. Your "Abstract" does not even come close to dealing with this fundamental and seminal issue.

Secondly, you did no research and have not presented any research as to the effects of EPO on the blood and how it stresses the heart, both at rest and at play. Where are the cardiology research studies? We know that EPO increases the number of red blood cells, but what you fail to add to the discussion which is absolutely essential is those studies that describe the physiological effects of EPO on the blood and the heart.

Without this scientific data your post is interesting, but useless.

 

[Dear Wiggo]

Here is the problem with your analysis. It focuses on whether or not EPO was the direct cause of the deaths of an unascertainable sample of cyclists. The ONLY way to know this is to obtain the autopsy reports of each and every rider for whom it is claimed or is suspected of dying due to the effects of EPO. Your "Abstract" does not even come close to dealing with this fundamental and seminal issue.

Secondly, you did no research and have not presented any research as to the effects of EPO on the blood and how it stresses the heart, both at rest and at play. Where are the cardiology research studies? We know that EPO increases the number of red blood cells, but what you fail to add to the discussion which is absolutely essential is those studies that describe the physiological effects of EPO on the blood and the heart.

Without this scientific data your post is interesting, but useless.

From memory EPO stimulates heart muscle growth, angiogenesis, but there were also studies on EPO effect on heart lesions (?) Very dim, distant memory.

 

[Merckx index]

Here is the problem with your analysis. It focuses on whether or not EPO was the direct cause of the deaths of an unascertainable sample of cyclists. The ONLY way to know this is to obtain the autopsy reports of each and every rider for whom it is claimed or is suspected of dying due to the effects of EPO. Your "Abstract" does not even come close to dealing with this fundamental and seminal issue.

Secondly, you did no research and have not presented any research as to the effects of EPO on the blood and how it stresses the heart, both at rest and at play. Where are the cardiology research studies? We know that EPO increases the number of red blood cells, but what you fail to add to the discussion which is absolutely essential is those studies that describe the physiological effects of EPO on the blood and the heart.

Without this scientific data your post is interesting, but useless.

1) this was not "my" research, and I didn't take a position on its validity

2) the author very explicitly pointed out the problem of not having access to autopsies. This doesn't mean he can't make any contribution to the problem. You work with what you have.

3) The author never concluded that EPO did not cause these deaths, at least in the end he concluded that the evidence that they didn't was (much) better than the evidence that they did. When people make a claim that something is the cause of death, the burden of proof is on them to show this, not on others to show that this is not the case. The author is not saying, "EPO was not the cause." He's saying, "you can't conclude that EPO was the cause." When in fact a large number of people, including scientists, have been concluding this, citing papers that contain no research of their own, this is a very important conclusion to make. I would definitely disagree that this conclusion is useless, it's very useful in showing how unsubstantiated conclusions get passed on to the point where almost everyone assumes they are supported by evidence.

4) He did cite studies of EPO on cardiac function. albeit only at 50% HT. He also cited one study reporting structural damage to the heart in mice with an elevated HT, but in addition to having a level far beyond that reported for any cyclist (80%!), this was a chronic condition, contrasting with cyclists, who do not take EPO all the time. I have seen other studies of animals with HTs in the 60s with no apparent adverse effects, though they may have naturally occurring adaptations that allow such levels chronically.

I think I understand your point, though. Some people, like these idiot fatty masters dopers, may read this article and say, hey, EPO is safe, I can jack up to 60%, and there will be no problems. And that would be unfortunate. From that point of view, you could argue that there is a greater burden of proof on those who say it probably didn't cause these deaths than those who insist it did. But if anti-doping officials really want to keep making this message, they ought to do studies to support it. It's not healthy to be promoting unsubstantiated claims, even if these claims are intended to protect people from themselves.

In any case, this guy is a historian. He's concerned not with getting some message out, but in understanding why a certain notion that is mostly unsupported came to be taken as gospel by so many. And as i said before, I think it's very useful to understand this.

 

[frenchfry]

Here is a list of cyclists who died mysteriously of heart related problems in the early 2000s. This is not proof they died of EPO use, could just be coincidence.

Denis Zanette (Italy)

Died January 11 2003, aged 32

Zanette, right, collapsed after visiting the dentist. Instantly linked to the use of the blood-booster EPO, which led to an outcry in Italy and demands for stricter drug controls.

Marco Ceriani (Italy)

Died May 5, aged 16

An elite amateur, Ceriani experienced a heart attack during a race, was admitted to hospital in a coma, and failed to recover consciousness.

Fabrice Salanson (France)

Died June 3, aged 23

Died of a heart attack in his sleep. Was found by his room mate in their team hotel. Had been about to compete in the Tour of Germany.

Marco Rusconi (Italy)

Died November 14, aged 24

Rusconi was leaving the party of a friend last November when he collapsed and died in a shopping centre car park.

Jose Maria Jimenez (Spain)

Died December 6, aged 32

Died from a heart attack in a psychiatric hospital in Madrid. Had retired two years previously but consistently claimed a comeback was imminent.

Michel Zanoli (Netherlands)

Died December 29, aged 35

Zanoli, who retired in 1997, was 35 when he suffered a fatal heart attack.

Johan Sermon (Belgium)

Died February 15 2004, aged 21

Suffered an apparent heart failure in his sleep. Had reportedly gone to bed early to prepare for an eight-hour training ride.

 

[RetroActive]

There were certainly a number of Dutch and Belgian amateurs dying of heart attacks in the spring of 1990. It was the first time I had ever heard of EPO. If someone has some old editions of Winning from Feb/Mar/Apr 1990 I'm sure it was being reported there. The deaths were certainly news, whether the cause was definitively attributed to EPO I can't remember for certain. It was the impression I was left with though, scared me at the time in a wtf way.

 

[D-Queued]

Here is a list of cyclists who died mysteriously of heart related problems in the early 2000s. This is not proof they died of EPO use, could just be coincidence.

...

Thanks, but these are post 2000.

In terms of deaths in the early 90s, to the list of Dutch and Belgian cyclists (which I do not have), we can add:

Philippe Casado
Born: Feb 1, 1964
Died: Jan 21, 1995

Age 30, apparent heart attack (in his backyard playing soccer with his son). He was still under contract with Jolly having switched in 1994.

Dave.

 

[Le breton]

Here is a list of cyclists who died mysteriously of heart related problems in the early 2000s. This is not proof they died of EPO use, could just be coincidence.

Denis Zanette (Italy)

Died January 11 2003, aged 32

Zanette, right, collapsed after visiting the dentist. Instantly linked to the use of the blood-booster EPO, which led to an outcry in Italy and demands for stricter drug controls.

Marco Ceriani (Italy)

Died May 5, aged 16

An elite amateur, Ceriani experienced a heart attack during a race, was admitted to hospital in a coma, and failed to recover consciousness.

Fabrice Salanson (France)

Died June 3, aged 23

Died of a heart attack in his sleep. Was found by his room mate in their team hotel. Had been about to compete in the Tour of Germany.

Marco Rusconi (Italy)

Died November 14, aged 24

Rusconi was leaving the party of a friend last November when he collapsed and died in a shopping centre car park.

Jose Maria Jimenez (Spain)

Died December 6, aged 32

Died from a heart attack in a psychiatric hospital in Madrid. Had retired two years previously but consistently claimed a comeback was imminent.

Michel Zanoli (Netherlands)

Died December 29, aged 35

Zanoli, who retired in 1997, was 35 when he suffered a fatal heart attack.

Johan Sermon (Belgium)

Died February 15 2004, aged 21

Suffered an apparent heart failure in his sleep. Had reportedly gone to bed early to prepare for an eight-hour training ride.

I am surprised that Fabrice Salanson's death should so often appear in such lists as I am under the impression that the autopsy had concluded to some sort of heart malformation.

Added later concerning Salanson:
http://www.cyclismag.com/article.php?sid=3291

Casado's case is mentioned above.
Halupzcok also comes to mind.
In the case of Draaijer, an autopsy was requested by his widow and soon after there was an article in L'Equipe where his wife, quoting the Doctor, said that Draijier's heart look like the heart of an old man (whatever that means).

In Gaumont's case the link would be harder to substantiate.

POST 2000http://en.wikipedia.org/wiki/Alessio_Galletti

 

[blackcat]

Brilliant find there MI.

These themes of things being massively exaggerated, taken out of context, and accepted as truth without any real argumentation even, are very common in cycling and anti doping discourse.

Also this about EPO being made at times to sound as if it was the only drug in sport. Though, yes, of course it was the worst.

when i was posting on this stat about the lowlands in the 80's, or early 90s, it did not read true, intuitively.

1. only lowlands? this was post-Barca Olympics, or around the time. No Italian riders?

2. they managed to go from epidemic numbers, in one locale, to 0.

how many have died in their sleep since? Fabrice Salanson at Le Brioche Boulangerie, and Kim Kirchen at High Road almost.

never met the smell test, when one turned on their cognitive faculties. And I just assumed it was true for about half a dozen years meself.

 

[spalco]

It may well be that there's no evidence behind this story, but I disagree with some of the authors assumptions; for example a simple answer why an amateur, a cyclocrosser or a rider in the offseason might have been using EPO could have been to use them as lab-rats.

Or more generally: Just because the author doesn't think it makes sense for a specific athlete to have used EPO doesn't mean he wasn't using it.

 

[blackcat]

Here is a list of cyclists who died mysteriously of heart related problems in the early 2000s. This is not proof they died of EPO use, could just be coincidence.

recently, there have been multiple footballers in Europe who have keeled over on the pitch.

It might be a 24 hour news cycling, and international sports news beeming into living rooms, and as such, produces the confirmation bias.

or it could be a cocktail of androgens, that will be nigh impossible to track down and pinpoint in a double blind study with placebo(s).

Compare cycling to football, and have a function according to professional athlete participation numbers. Cos football has manifold more pros on the continent and in UK.

 

[blackcat]

1) this was not "my" research, and I didn't take a position on its validity

2) the author very explicitly pointed out the problem of not having access to autopsies. This doesn't mean he can't make any contribution to the problem. You work with what you have.

3) The author never concluded that EPO did not cause these deaths, at least in the end he concluded that the evidence that they didn't was (much) better than the evidence that they did. When people make a claim that something is the cause of death, the burden of proof is on them to show this, not on others to show that this is not the case. The author is not saying, "EPO was not the cause." He's saying, "you can't conclude that EPO was the cause." When in fact a large number of people, including scientists, have been concluding this, citing papers that contain no research of their own, this is a very important conclusion to make. I would definitely disagree that this conclusion is useless, it's very useful in showing how unsubstantiated conclusions get passed on to the point where almost everyone assumes they are supported by evidence.

4) He did cite studies of EPO on cardiac function. albeit only at 50% HT. He also cited one study reporting structural damage to the heart in mice with an elevated HT, but in addition to having a level far beyond that reported for any cyclist (80%!), this was a chronic condition, contrasting with cyclists, who do not take EPO all the time. I have seen other studies of animals with HTs in the 60s with no apparent adverse effects, though they may have naturally occurring adaptations that allow such levels chronically.

I think I understand your point, though. Some people, like these idiot fatty masters dopers, may read this article and say, hey, EPO is safe, I can jack up to 60%, and there will be no problems. And that would be unfortunate. From that point of view, you could argue that there is a greater burden of proof on those who say it probably didn't cause these deaths than those who insist it did. But if anti-doping officials really want to keep making this message, they ought to do studies to support it. It's not healthy to be promoting unsubstantiated claims, even if these claims are intended to protect people from themselves.

In any case, this guy is a historian. He's concerned not with getting some message out, but in understanding why a certain notion that is mostly unsupported came to be taken as gospel by so many. And as i said before, I think it's very useful to understand this.

thanks Merckx for the contribution

 

[SundayRider]

Impossible to tell, very rare that a cyclist is taking EPO and absolutely nothing else. So far many of the Armstrong generation and the generation just previously to that do not seem to have a great deal of health problems, although I'm sure there might well be be posts to correct me on this. Maybe they just keep these problems quiet. Pantani was supposedly facing a lifetime of blood related health issues.

 

[lllludo]

Here is a list of cyclists who died mysteriously of heart related problems in the early 2000s. This is not proof they died of EPO use, could just be coincidence.

Denis Zanette (Italy)

Died January 11 2003, aged 32

Zanette, right, collapsed after visiting the dentist. Instantly linked to the use of the blood-booster EPO, which led to an outcry in Italy and demands for stricter drug controls.

Marco Ceriani (Italy)

Died May 5, aged 16

An elite amateur, Ceriani experienced a heart attack during a race, was admitted to hospital in a coma, and failed to recover consciousness.

Fabrice Salanson (France)

Died June 3, aged 23

Died of a heart attack in his sleep. Was found by his room mate in their team hotel. Had been about to compete in the Tour of Germany.

Marco Rusconi (Italy)

Died November 14, aged 24

Rusconi was leaving the party of a friend last November when he collapsed and died in a shopping centre car park.

Jose Maria Jimenez (Spain)

Died December 6, aged 32

Died from a heart attack in a psychiatric hospital in Madrid. Had retired two years previously but consistently claimed a comeback was imminent.

Michel Zanoli (Netherlands)

Died December 29, aged 35

Zanoli, who retired in 1997, was 35 when he suffered a fatal heart attack.

Johan Sermon (Belgium)

Died February 15 2004, aged 21

Suffered an apparent heart failure in his sleep. Had reportedly gone to bed early to prepare for an eight-hour training ride.

You can add to the heart attack list of the late 90s-2000 : Bert Osterboosch, Geert Van de walle, Connie Meijer, Johan Sermon 21 ans, L'Italien Marco Ceriani, 18 ans. Kenny Vanstreels, 20 ans. L'Italien Denis Zanette, 32 ans. Johan Mannaert, 20 ans. Marc Siemons le 17 avril 2002, 36 ans. Kim Van Bouwel, 21 ans. Glenn Fockaert, 20 ans. Le Portugais Manuel Abreu, 34 ans. Paul Haghedooren, 38 ans.

 

[rhubroma]

Rube, I read about your horrific accident on a bike. Hope for a speedy recovery, and don't be afraid to take the PEDs for this. Is there going to be a lawsuit involved?

To your question, I think much of the rationale was an attempt to level the playing field, reduce the potential advantage riders could gain (though ironically, when everyone started taking it, the field was probably less level, as riders with low HTs were favored).

They may have also believed the stories of EPO deaths. I did, they sounded quite plausible to me at the time. It's only recently, when I have read of people, and animals, with natural HTs in the 60s, that I have wondered if the viscosity argument was overblown.



The author also mentions Lyle Alzado as another myth.

Thanks Merckx index and yes I will be sueing the delivery truck driver, as it was entirely his fault.

Thanks to the others for responding to my inquiry. I certainly can't figure it out. Years ago some cyclists I know were on a training ride somewhere I'm quite familiar with and, one of the guys who was about 40 years old at the time suddenly dropped dead on his bike. It was rumored that his heart "exploded" because his blood was like sludge from heavy EPO use.

While this may be just a rumor, my sources believed that's indeed what happened.

 

[therhodeo]

I was going to point out that undiagnosed congenital heart defects aren't uncommon (my son has a CHD) but normally when that manifest itself its during exertion not after.

 

[More Strides than Rides]

I don't like the way he is so dismissive the off-season and amateur use of epo. The off season and amateur ranks are the perfect time to practice, experiment and hone one's use with even less control than the pro competition season.

Also, as seems to be pointed out by others, he missed many other deaths of seemingly related causes.

He may be right that there is no direct evidence that epo caused these deaths, but the implication of his writing is to say the original conclusion was wrong, which cannot be said.