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EPO is apparently useless

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Dec 21, 2016
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To access the article's full text (either HTML or PDF) you need to register an account for the Lancet's website. Registration is free and will grant you access to the article (free access). Obviously Elsevier wants a bit of personal information (job etc.) and tries to subscribe you to a newsletter, but you don't have to comply with that. You don't even have to use a valid email address.

I've read just read the paper, but as I can't really keep my eyes open, commenting on it has to wait until tomorrow. What I can say is that the general design seems fine and that they've more-or-less performed the statistical analyses I expected them to perform. (I don't know a lot about performance tests, so I can't comment on the ones they've used.)
 
Alex Simmons/RST said:
6 weeks huh? That's a pretty normal time period for regular aerobic training impacts to really start to show up in your performance data and for maximal aerobic/HIT work to begin to show a performance plateau and eventual decline. Perhaps there is a training bias?
“Participants were instructed to maintain their usual training programme throughout the study.”

There should have been no benefit of training to either group, though differences in training would add to the heterogeneity of the groups, and I would think make comparing the groups just by averaging the results from the two dozen or so subjects even more complicated. The authors say all the subjects used a bike with a power meter, that recorded all their training rides, and that the average amount of training was roughly similar for the two groups. But If I were going to do a study like this, I would want all the subjects to undergo a similar training program, to minimize the effect of that variable. I would also want to record a climbing time prior to treatment, so the climbing time after treatment could be compared to a baseline, for each rider as well as for the group.

At least the maximal and submaximal power tests all were carried out before treatment as well as at one time (submaximal) or multiple times (maximal) after the treatment was begun, but the data are not broken down for individuals in the article per se. They may be included in an Appendix referred to by the authors—I’m sure they have the data somewhere--but unfortunately, the Appendix is not included in the free access to the article following registration.

I also noticed for the first time that four of the subjects did not finish the climb, and the authors factored this in, rather than discard these subjects. Also of note, about 60% of the riders treated with EPO thought/guessed they were receiving placebo treatment. I remember when Floyd confessed, he mentioned that he never thought his doping helped that much. OTOH, I believe Tyler Hamilton was quite explicit in saying he felt a major difference. I think there are probably substantial individual differences in not only the effects of EPO on performance, but in the perception of individuals of the effect.

I've not read it, don't think I need to since (i) it's clearly just plain silly and (ii) it's of no value to me as an ethical coach.
Though I think it's way over the top to conclude that EPO has no effect, if this study plants doubt in the minds of some riders who are tempted, that could be beneficial. A rider is already facing the possibility of testing positive and being suspended, and thus must weigh the potential PE vs. the risk. Any study that claims there is no enhancement, I suppose, will increase the likelihood that fear of risk will carry the day.
 
Dec 21, 2016
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Merckx index said:
They may be included in an Appendix referred to by the authors—I’m sure they have the data somewhere--but unfortunately, the Appendix is not included in the free access to the article following registration.
Just a quick reply, the appendix is available for download here. In most journals, the appendix and other supplemental materials are distributed separately from the paper. (If the link doesn't work, go to the paper's landing page and click "Supplemental Materials".) The appendix doesn't list the full data set.

On Training
One thing to note is that training efforts were measured and no significant results between the groups were found for training hours, training power, and training distance. While training may indeed be a bias, the random design of the study makes it unlikely the bias is systematic towards one group, given the checks they did. So, the averages should not be systematically biased towards one group.

However, while the between-group differences may not be biased by differences in training, it may increase the individual differences or variance within the groups. As far as I can tell, training effort is not included in any of the statistical models, increasing the error/unexplained variance of the model and thereby decreasing the power of the statistical test. This means that it is less likely to reject the hypothesis that EPO does nothing (the null hypothesis) even if in reality EPO is beneficial. However, including training variables in the model would mean that more effects (parameters) should be estimated, also decreasing the power of the procedures.

Still, I'm not convinced that this truly was a factor in the null finding, although it couldn't hurt to perform a study in which training was more closely monitored and/or controlled.

On the 45-minute test
One thing thing that I do question is the 45-minute test which serves as the foundation for the conclusion that EPO is not beneficial in cycling. (The maximum power tests do show a beneficial effect of EPO). While I'm not an expert in cycling performance tests, almost every text I've read on cycling training and time trialing mentions that pacing a 45-60 minute effort is really difficult. (It's usually mentioned in relation to FTP-tests.) I know it certainly took me a while to get it right when I started racing and even then I sometimes got it wrong. Given that most of the participants are not competing or competed at club level, I find it unlikely that most would have the skills to perfectly pace such an effort.

So, what are we actually measuring? True maximum submaximal performance? Their ability to pace 45-minute efforts? The effects of experiencing it at time point 1, learning from it, and then doing better at day 46 (i.e., a testing effect)? Due to the difficulty of pacing and the relative inexperience of the participants, both the validity (i.e., does it truly measure submaximal performance) and the reliability (i.e., does the test provide consistent results/would the same participant get similar results if repeated under similar conditions) of the measure can be questioned. As far as I can tell they did not analyse the efforts to check for pacing problems. (This is also evident by the fact they don't mention pacing problems; I find it highly unlikely that all participants paced both their tests appropriately.)

This means that the results may not only be influenced by the true physical abilities, but also by their ability to pace the effort. This increases individual differences and thereby the error/unexplained part of the statistical model. As with the training effects mentioned above, this decreases the power of the statistical tests. As the probability values do approach significance (p = 0.086, 7.66 watts average increase for placebo, 13.55 watts average increase for EPO), problems with this test may have had a severe influence on the results of the analysis.
 
Re: Dutch Study: "EPO little to no effect on trained cyclist

Tonton said:
How do you say BS in Dutch? :D
Literally:
Stierenstront, stierenkak.

Figuratively ("nonsense"):
Onzin, flauwekul, zever in zakskes.

For a short term effect things like amphetamines probably work more directly, but EPO is an enormous help to improve endurance in the longer term and enables riders to train more kilometers without getting exhausted.
 
Dec 21, 2016
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Re: Dutch Study: "EPO little to no effect on trained cyclist

Strange Loop said:
Tonton said:
How do you say BS in Dutch? :D
Onzin. (Although that's doesn't have the same negative connotation and most here will understand/use "******").

You can find the thread for this study here: http://forum.cyclingnews.com/viewtopic.php?f=20&t=33344
Can the mods merge this thread with the one above? Because the same article is discussed in that one, with a lot more replies.
 
Jul 5, 2009
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Yup. EPO has no effect. That perfectly explains why Riis won a Tour. Or the 90's in general. Doesn't help people with kidney failure either. Useless drug. Amgen went bankrupt.

John Swanson
 
Re: Re:

sniper said:
Escarabajo said:
...
Pantani, Riis, Armstrong, Virenque. All of them were wrong!!!
The latter three riders were likely using motorized bikes (and possibly the first rider, too) at various points in their carreer, so unfortunately they are not the best examples for measuring/analyzing the impact of EPO.
Oh please. Stop it!!!

And Bush killed Kennedy!!
 
May 26, 2009
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Re:

ScienceIsCool said:
Yup. EPO has no effect. That perfectly explains why Riis won a Tour. Or the 90's in general. Doesn't help people with kidney failure either. Useless drug. Amgen went bankrupt.

John Swanson
That's what always makes me roll my eyes... "There's no reliable data"... when there's a Mount Ventoux of aggregate of real world data pointing to the importance of Epo :Neutral:

Then again, it fits in what I think of the Dutch resurgence of the last ten years in all manners of sports.. we saw it before in the tail en d of the eighties. Soccer, Skating, Cycling, etc.. etc.

And lo and behold: We had a soccer team finding its groove, Skating has become a joke, our athletes all of a sudden can sprint again, we have our swimming stars... On cycling in that same timeframe we managed to get our own climbers again (Mollema/Ten Dam, Gesink), culminating in TD's win of the Giro (and SK should have won it last year).

It's a coincidence.. really. Just as the reports about how Epo does not work all of a sudden being pumped through our universities (Hello Harm Kuijpers). I assume these researchers are kosher, but one must wonder why this research came out at a time where this tiny country all of a sudden is performing on all cilinders again.

In earnest: In the timeframe 2008-2012 we made a gargantuan leap of which we are still seeing the effects.

=> When a country all of a sudden has a Renaissance in all kinds of sports, there's a Puerto behind it. With the obligatory smoke screens.
 
Oct 16, 2010
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Re:

ScienceIsCool said:
Yup. EPO has no effect. That perfectly explains why Riis won a Tour. Or the 90's in general. Doesn't help people with kidney failure either. Useless drug. Amgen went bankrupt.

John Swanson
EPO has great effect.
But I wouldn't say Riis 1996 hits it out of the ballpark.
Riis was on EPO well before 1996.
1996 something else happened.
In addition to EPO of course.
 
May 26, 2009
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If we look at the results of the years before it's hardly revolutionary. Big Mig made a huge drop, but every name (including Riis) in that top ten had bona-fide GT history (except neo-pro Jan, but he was not exactly a star out of nowhere, we knew he was a huge talent).

Same with the classics.. Musseeuw before, Musseeuw after.

Yeah, all Epo fuelled, certainly, but contrary to the dramatic 1992 disappearance of the old guard, most stars in the epo era did fine during that decade.

Sorry, I think your hammering on the motors'is silly. There's no indication that this happened, no rumors. Cycling is way too leaky to make that plausible.
 
Oct 16, 2010
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Re:

Franklin said:
...There's no indication that this happened, no rumors.
Lol, I guess.

With all due respect, maybe you could consider reading the appropriate threads on motors first and maybe even try to address (if only a fraction of) the relevant evidence and arguments put forth therein.
Otherwise there is no breeding ground for a fruitful discussion on the topic.

To get back to my original point:
if you want to address the issue of the impact of EPO on (cycling) performance scientifically, then you'll want to control as many variables as possible.
So ideally you'll want to take performances of which you can be sure they did not involve motors.
As much as it saddens me, for reasons extensively laid out in the "first motor caught" thread, Riis 1996 is no such performance.

Indeed, by extension, it means that most of the topperformances from the mid-90s onwards are, in my view, unreliable data points. It's a sad state of affairs, and I wish it were different. I wish there was no cheating and no omerta. I really do.
 
May 26, 2009
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I read them. Point to a rumor originating in that era and we can talk. Varjas showing a motor fits in a Trek *shrug*.

Let's turn this around, now shall we? Point out the dramatic change in 1996 and explain why the only one who got caught was Miguel Indurain. Perhaps his bike was unsuited for a motor. Oh wait, he had exactly the same bike as Riis. Maybe Miguel was a more honest person? Miguel lacked the cash?

Serious Snip[er, you are a good guy, but considering the dramatic change clearly is not supported by data your whole premise is odd. Suddenly everyone gets a motor except Miguel Indurain? That's extremely farfetched.
 
Oct 16, 2010
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Re:

Franklin said:
I read them. Point to a rumor originating in that era and we can talk. Varjas showing a motor fits in a Trek *shrug*.

Let's turn this around, now shall we? Point out the dramatic change in 1996 and explain why the only one who got caught was Miguel Indurain. Perhaps his bike was unsuited for a motor. Oh wait, he had exactly the same bike as Riis. Maybe Miguel was a more honest person? Miguel lacked the cash?

Serious Snip[er, you are a good guy, but considering the dramatic change clearly is not supported by data your whole premise is odd. Suddenly everyone gets a motor except Miguel Indurain? That's extremely farfetched.
I didn't say "everyone gets a motor".
I said top-performances from the mid 90s onwards, in my view, don't offer reliable data points.
 
Topics merged. Let me know if there is an issue with the merge, or anything else.

I too find the study not thorough, as they didn't use pros, and it looks like it took nothing into factor over long term training, plus day to day recovery, where some of the biggest gains are likely to be attained. It also jumps to conclusions, and as DFA123 noted on page three, it's completely irresponsible for a scientist to make a presumption that Armstrong "lost his jerseys to a drug that had no effect".

What's next? A study showing the minimal amount Floyd was over the limit on his testosterone positive had no affect on his performance on the Joux Plane?
 
Re: Re:

sniper said:
Franklin said:
...There's no indication that this happened, no rumors.
Lol, I guess.

With all due respect, maybe you could consider reading the appropriate threads on motors first and maybe even try to address (if only a fraction of) the relevant evidence and arguments put forth therein.
Otherwise there is no breeding ground for a fruitful discussion on the topic.

To get back to my original point:
if you want to address the issue of the impact of EPO on (cycling) performance scientifically, then you'll want to control as many variables as possible.
So ideally you'll want to take performances of which you can be sure they did not involve motors.
As much as it saddens me, for reasons extensively laid out in the "first motor caught" thread, Riis 1996 is no such performance.

Indeed, by extension, it means that most of the topperformances from the mid-90s onwards are, in my view, unreliable data points. It's a sad state of affairs, and I wish it were different. I wish there was no cheating and no omerta. I really do.
What is your LOL for???
He was talking about the no test EPO era.

Please bring any rumor, book quote, or interview, confession about that era the motors were being used or cut the crap!!!

Who cares about the motor in an era when they were free to dope with EPO. Motor + free EPO, LOL. That's right I want to see those climbs!
 
Havent read the study. If the aim is to give a more nuanced view of the chain "increased hb mass -> increased vo2 uptake -> similarly increased performance capacity -> similarly increased actual race performance" then fair play. Even so it is stating a truism that can be spun in very unproductive ways as per usual.

If the argument is that epo is useless as a means of doping, then, well, it is so useless that evolution has made kidneys produce it naturally to regulate RBC production in humans. Clearly useless.
 
Dec 21, 2016
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Re:

ScienceIsCool said:
Yup. EPO has no effect. That perfectly explains why Riis won a Tour. Or the 90's in general. Doesn't help people with kidney failure either. Useless drug. Amgen went bankrupt.

John Swanson
I don't get this reply, but you're probably trolling. However, your username is "ScienceIsCool", so you apparently claim to have a thing for science.

The article, not the topic title, claims that EPO is not effective in enhancing performance; nowhere does it claim that EPO does "nothing" in the case of kidney failure. Now, I believe there are some severe flaws in the article, I wrote some of the problems I have down in this post, but there are a lot people commenting who didn't even bother to read the article (free access!).
 
Jun 30, 2014
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Small doping scandal at the Österreich Rundfahrt, Matija Kvasina got busted busted for Molidustat, an HIF-stabilizer that stimulates erythropoietin production without hypertensive effects, as far as I know it's not really on the market and still in the riall phase, but don't quote me on that.
Sources: http://www.tuttobiciweb.it/2017/07/04/102830/positivo-il-croato-matija-kvasina-epo-doping-tuttobiciweb
http://www.laola1.at/de/red/sport-mix/radsport/oesterreich-rundfahrt/oesterreich-rundfahrt-teilnehmer-wegen-dopings-suspendiert/
Not a huge surprise, a guy who has been riding since 2004 and suddenly became way better in his 30ies.
Felbermayr - Simplon Wels are also one of the shadier Aistrian CT teams, Zoidl was never able to replicate the results that he got in 2013 when he was riding for them.
 
Jul 4, 2009
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Re: Re:

Strange Loop said:
ScienceIsCool said:
Yup. EPO has no effect. That perfectly explains why Riis won a Tour. Or the 90's in general. Doesn't help people with kidney failure either. Useless drug. Amgen went bankrupt.

John Swanson
I don't get this reply, but you're probably trolling. However, your username is "ScienceIsCool", so you apparently claim to have a thing for science.

The article, not the topic title, claims that EPO is not effective in enhancing performance; nowhere does it claim that EPO does "nothing" in the case of kidney failure. Now, I believe there are some severe flaws in the article, I wrote some of the problems I have down in this post, but there are a lot people commenting who didn't even bother to read the article (free access!).
....there is a form of irony that is used extensively in these parts, its called sarcasm, you should take a few moments to acquaint yourself with it....

....just sayin' eh....

Cheers
 

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