Sport in History

ISSN: 1746-0263 (Print) 1746-0271 (Online) Journal homepage: http://www.tandfonline.com/loi/rsih20

The Invention of a ‘Drug of Mass Destruction’: Deconstructing the EPO Myth Bernat López To cite this article: Bernat López (2011) The Invention of a ‘Drug of Mass Destruction’: Deconstructing the EPO Myth, Sport in History, 31:1, 84-109, DOI: 10.1080/17460263.2011.555208 To link to this article: http://dx.doi.org/10.1080/17460263.2011.555208

Published online: 09 Mar 2011.

Submit your article to this journal

Article views: 3534

View related articles

Citing articles: 15 View citing articles

Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=rsih20 Download by: [37.44.207.15]

Date: 17 January 2017, At: 07:55

Sport in History Vol. 31, No. 1, March 2011, pp. 84
109

The Invention of a ‘Drug of Mass Destruction’: Deconstructing the EPO Myth Bernat Lo´pez

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.

Introduction The Danish sports scholar Verner Møller has labelled the anti-doping campaign ‘a crusade that must not fail’,1 one in which seemingly ‘the ends justify the means’.2 He advances the hypothesis that the officials who are leading it might be regarding ‘the fight against doping as a war in which a form of emergency situation prevails’.3 This is certainly not an improbable stance, as one of the favourite metaphors of the anti-doping campaigners Bernat Lo´pez, Department of Communication Studies, Universitat Rovira i Virgili, Tarragona, Spain. Correspondence to: [email protected] ISSN 1746-0263 print; ISSN 1746-0271 online/11/010084-26 # 2011 The British Society of Sports History DOI: 10.1080/17460263.2011.555208

Sport in History 85

themselves compares or equates their efforts to eradicate doping with a war. One that must be won at any cost because if not, ‘then sport
to use the dominant discourse of the area- will be at the mercy of the needle’.4 In the course of such a war empirical evidence, historical rigour and honest research might be sacrificed for the sake of the cause. As the cliche´ goes, truth is the first casualty of war, and the war on doping is no exception to this point. This article is inspired by another of Møller’s contributions,5 as well as by the book written by sports historian Paul Dimeo A History of Drug Use in Sport,6 and an article by the sports scientist Bryan Denham.7 These texts are underpinned by a deliberate, open desire to unveil the historical truth concerning some of the most often repeated stories about the use of doping substances in sport since the late nineteenth century. In a daring and unfashionable modernistic approach, these authors claim that events occur one way and not another; that reconstructing them as closely as possible to their original factuality does matter in order to make sense of them, to illuminate our current debates and concerns, and to show how later ideas have been informed and policies justified by misrepresentations of the past. Møller’s article presents a thoroughly researched and convincing revision of the circumstances surrounding the death of the Danish cyclist Knud Enemark Jensen in the Rome Olympics of 1960. This was a central event in the history of anti-doping as it ‘placed the anti-doping campaign on the agenda of sports politics
and, indeed, of politics as a whole’.8 Jensen’s death being quickly and almost unanimously attributed to amphetamine use, his lifeless body became ‘proof of the health risks of doping’.9 There is almost no historical approach to doping in the academic literature that fails to mention Jensen’s death and its link with the dangers of drug use by athletes. But, as Møller has demonstrated, none of these accounts provide the essential evidence needed to substantiate such serious allegations, an omission that might be rightly considered as ‘scientifically irresponsible’10 and that almost degrades the resulting claims to the ‘category of gossip’.11 Dimeo carries out a similar deconstruction (if less developed than Møller’s) of another of the accounts of a ‘doping casualty’: the case of the English cyclist Arthur Linton in the late nineteenth century, who allegedly died of ‘an overdose of drugs’.12 After revising the available evidence, which none of the authors making this claim have done so far, Dimeo concludes that

86

B. Lo´pez we cannot say that his death was due to drug use because there is no evidence either way. We definitely cannot say that it was ‘recorded’ as such, or that it was in 1886. . . . Therefore we cannot interpret the fact of his death as proof of the continuity and health risks of doping in history.13

In another such example, Denham reviewed the dominant journalistic account of the alleged drug-related death of American football player Lyle Alzado in 1992. Despite the fact that ‘medical science did not demonstrate a cause-effect relationship’ between his brain lymphoma and steroid intake, ‘many journalists in print and broadcast media assumed a connection
and perhaps still do’.14 The reason could be found in ‘the dramatic manner in which Alzado revealed his condition’ in a popular television show and in the magazine Sports Illustrated. This case analysis, according to the author, ‘addresses the manner in which media contribute to panic and hysteria with regard to drug use in Western society’.15 Examining the mythical nature of these stories is bad news for the antidoping campaign, because athletes, policy-makers, media and public opinion would be less convinced by the health-risk arguments if the history of doping were short of victims. It is indeed ‘astonishing’16 that the campaign has been so hard-pressed to put together a list of doping casualties, at least before the early 1990s, that can live up to the dramatic claims concerning the lethal effects of performance-enhancing substances. In fact, most of the anti-doping literature mentions little more than two recorded victims in the history of doping up to 1960, Jensen and Linton, despite unanimously accepting that substance use (or ‘abuse’, as the campaign often puts it) is as old as sport itself and therefore goes back as far as the Olympics in ancient Greece.17 After 1960 the main cases are that of Tom Simpson, the British cyclist whose death during the thirteenth stage of the 1967 Tour de France has been insistently attributed to amphetamine abuse,18 and the American sprinter Florence GriffithJoyner. The ethnocentric nature of most of this literature,19 and the narrowness of its source range, has resulted in the omission of some possible victims in the list, namely those from the fringes of rich, developed Europe. An example would be the Spanish cyclists Joaquı´n Polo and Rau´l Motos, who died during the course of the second stage of the Volta a Portugal on 3 August 1958.20 The Spanish press reports of the time mention sunstroke as the cause of these tragic deaths, but had the anti-doping campaigners been aware of them, one can speculate they would have been attributed to the intake of amphetamines or any other sort of stimulant.

Sport in History 87

The focus of this article is the alleged ‘sudden spate of deaths from heart failure among professional cyclists’21 in Belgium and Holland in the late 1980s and early 1990s. The time span quoted for these deaths in academic and journalistic sources varies greatly, as will be seen below. A total of 18 cyclists, the claim goes, passed away in ‘mysterious’22 circumstances, in a short period of time and ‘in just two countries’.23 According to Waddington, ‘the overwhelming probability’24 is that a new drug, recombinant human erytropoietin, rhEPO or, more plainly, EPO, was involved in these deaths. This sensational story, if it were true, would solve at once and forever any credibility problem arising from the aforementioned shortage of victims in the anti-doping campaign’s list of casualties. This might explain why it is one of the most repeated claims in the academic and journalistic literature about the issue. Yet it is not true. Or at least no truer than the claims about a doping link in the deaths of Linton, Jensen and Alzado. This article will present enough evidence to argue that it is actually another myth of the antidoping campaign, its flagship myth, one could say, one that succeeded in scaring the athletes themselves25 and generated an outcry and concern among scientists, journalists, policy-makers and public opinion worldwide. A new drug had appeared that could be convincingly blamed for a spate of sudden deaths among healthy, young athletes: a true and fearsome drug of mass destruction. The anti-doping campaign could at last be presented not only as a war to preserve the integrity or spirit of sport, an argument that in itself does not seem to have the potential to awaken public opinion and policy-makers to the dangers of doping: it was now very much about saving the lives of the athletes themselves. As Randy E. Eichner, a haematologist at the University of Oklahoma and one of the first experts to identify the problem, dramatically put it: ‘I am not so much concerned with getting the athlete to the finish-line first, but with getting him there alive.’26

‘Athletes were dropping dead’ The journalist and anti-doping campaigner Paul Kimmage, a former professional cyclist, opens the epilogue of his enthralling autobiography Rough Ride with this sensational story: One month after the final chapter of Rough Ride was delivered to the publishers in 1990, professional cycling was rocked by a spate of sudden and mysterious deaths.. . . In the six years since the death of

88

B. Lo´pez Johannes Draaijer [a Dutch cyclist who died in 1990], the sport had edged its way to the brink of the abyss.27

Kimmage recounts the following story contained in a report on EPO use in Italy in the early 1990s by the renowned Italian doctor Sandro Donati: There was the confession of the top Italian ‘Y’ and his explanation of how he had narrowly cheated death after a stage of the Tour of Italy. Boosted before the stage by an injection of EPO, he had gone to bed that night and slept peacefully for two hours, unaware that the oxygenenhanced blood, flowing through his veins, was rapidly thickening to treacle. EPO is transformed into a lethal cocktail, not during a race when the blood is pumped around the body by a 180 beats-perminute, high-revving, super-fit, heart rate but at night when the revs drop way below the norm. As Y’s pulse dropped to a low of twenty-five beats per minute, his blood began to clot and his heart began to stall. Had he not been sharing with a team-mate, there is every chance they would have found him dead in the morning . . . Y lived to tell the tale. Others were not so fortunate.28

Robin Parisotto, a scientist who acted as principal researcher in the EPO 2000 Project at the Australian Institute of Sport, which developed the first-ever blood tests to be used at the Olympic Games,29 is no less sensational in his account of these events. In his book Blood Sports: The Inside Dope on Drugs in Sport he writes: Between 1987 and 1990, 18 cyclists died tragically and suddenly all from heart attack or stroke. EPO was known to thicken the blood
the common cause of heart attack or stroke. Many victims developed clots that broke off and travelled to their hearts or brains; others died of simple cardiac arrest, the organ struggling to pump blood the consistency of oil.30

Another authoritative voice in the scientific field is Dr David Gerrard, an associate professor of sports medicine, chair of the New Zealand Sports Drug Agency and member of the board of the World Anti-doping Agency.31 Concerning the facts under discussion he explains: During the 1980s and early 1990s the emergence of EPO as a performance-enhancing drug of choice by cyclists drew international attention when a number of young cyclists in Belgium and Holland died suddenly and inexplicably. . . . When the affected arteries were those that supplied the brain or the heart, formerly fit young athletes were literally dropping dead from massive strokes and heart attacks. Post-mortem studies revealed the extent of the damage. How tragic

Sport in History 89 that it took such graphic consequences to highlight the recklessness of such acts of drug abuse?32

These three testimonies have been selected as they can be considered to be representative of journalistic (Kimmage), populist-scientific (Parisotto) and academic-scientific (Gerrard) discourses. All three sensationalize the facts under discussion, whose veracity they do not seem to doubt in the least, but also lack evidence to support their claims. Kimmage and Parisotto fail to quote a single source, neither for such assertions as that blood thickness ‘is the common cause of heart attack’ nor that EPO works at such speed that a few hours after an injection your blood thickens ‘to treacle’. Gerrard, on the other hand, in his paper published in the academic journal Sport in Society, does provide a source for his claims: a chapter of the book Clinical Sports Medicine.33 The latter reads as follows: ‘More recently, the use of the drug erythropoietin has allegedly become widespread among endurance sportspeople and may have contributed to the death of a number of European cyclists’.34 This author does not quote any source for her claim, and unlike Gerrard, gives neither details of the nationality of the victims nor the period when these alleged deaths occurred. She is also more cautious concerning their relationship with EPO intake (‘may have contributed’). And she does not mention having accessed the ‘postmortem studies’ that ‘revealed the extent of the damage’. Gerrard is obviously adding data from his own (blurred) knowledge of these events, apparently quoting from hearsay rather than solid scholarship. This lack of preciseness and evidence concerning these deaths is in fact the norm for the 36 academic texts mentioning them that I have reviewed in my research. They fail to quote the source of their claim (in 10 cases), quote another scholar who fails to do so, or instead they (or the quoted academic source) refer to an expert or journalistic source which in turn does not mention any solid source (or any source at all) to substantiate the claim. This has resulted in a quite unscholarly imprecision regarding the number of victims (ranging from an indeterminate ‘several’, to ‘about 20’, with intermediate figures of 5, 12 and 18 being provided as well), countries of origin (the victims being referred to as European, Dutch, Dutch and Belgian or even Scandinavian) and time span of the deaths (‘during the 1980s and early 1990s’, or ‘between 1997 and 2000’, or ‘in the early 1990s’, or ‘between 1987 and 1991’). The most common figures, though, refer to 18 Dutch and Belgian cyclists having died in a period spanning from 1987
1988 to 1990
1991.

90

B. Lo´pez

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. In search of evidence A source analysis reveals that only two of the 61 reviewed texts (including academic and journalistic pieces) quote more or less solid original sources for the figures they provide: a spokesperson of the Dutch cycling federation and a Belgian sports physician. Both are newspaper, not academic, articles. The obvious conclusion is that the claim about this ‘sudden spate of deaths’ is very poorly substantiated. So what is the truth concerning the bare facts of these deaths (who, how many, where, when, why)? In the absence of a central register to record this kind of events in the relevant countries and taking into account the material difficulty of accessing the autopsy reports (if they actually exist), establishing this truth seems impossible. One place to begin would be a review of all sudden deaths of cyclists between 1987 and early 2010 crossreferencing data from the LexisNexis database of newspaper articles, other newspaper archives, cycling sites and personal blogs. Such a chronologically broad search would allow for a proper contextualization of the deaths under discussion, in addition to providing evidence and details about their actual occurrence. The total figure
see Table 1
is 49 cyclists: 22 Belgians, 11 Dutch, 5 Italians, 3 French, 2 British, 2 Australians and 1 Spaniard, Colombian, Norwegian, and Pole. Between 1987 and 1990, references to 8 Dutch, 3 Belgian and 1 French rider have been found. The total figures for the period 1987
1992 are: 9 Dutch, 6 Belgian, 1 British, and 1 French (17 in total). To what extent one could talk about a ‘statistical aberration’36 concerning these deaths? The resulting picture is indeed quite dramatic and one must acknowledge that it even gives ground for being suspicious. But let’s put it another way: 1 Dutch victim in 1987, 2 Dutch in 1988, 2 Dutch in 1989, 3 Dutch,

Sport in History 91

3 Belgian and 1 French in 1990, 1 British and 1 Belgian in 1991, 1 Dutch and 2 Belgian in 1992. Or an average of 1.25 sudden deaths per year per country in Holland and Belgium, which indeed may not be out of line with existing statistical series of sudden death in athletes. A number of studies can help us understand patterns of sudden death among athletes. For example, Van Teeffelen et al.37 estimated the annual incidence of sudden deaths in all sports in the Netherlands in the early 1990s to be around 150. Between 1995 and 2006, a total of 180 sudden deaths were officially recorded among athletes in Spain38
an average of 15 a year.39 Forty-two victims (23.3%) were 20 years old or less. Of course, these are figures for a range of age brackets, sporting activities and levels of practice: cycling alone recorded a remarkable 39 deaths for the whole period, 21.66% of the total, but was only second to football, which recorded 40 victims. None of these deaths was officially attributed to drug intake (let alone EPO) in the autopsy reports, but to a wide range of cardiovascular ailments.40 Nonetheless, Spanish doctors failed to establish a cause for a total of 14 deaths, all of them of athletes under 30. According to Manonelles et al., ‘it has been proven that in some cases [of sudden death involving people with a structurally normal heart] the alteration is to be found at a molecular level, in the electrolyte channels that determine the cardiac beat’.41 Thus, even unexplained deaths should not lead naturally to accusations of doping. In the United States, Maron42 reported in 2003 on 387 cases of sudden death in young athletes recorded by the registry of the Minneapolis Heart Institute Foundation (no time span is mentioned). Of these, only 4 were attributed to ‘drug abuse’, slightly over 1% of the total. In a recent statistical study, Maron et al.43 reviewed 1,866 recorded cases of sudden death in young athletes in the USA between 1980 and 2006, a yearly average of 71.7. Only 2% were attributed to ‘illicit drug use’.44 EPO is not mentioned. In a broader geographical and chronological framework, Bille et al. published a systematic review of the literature concerning sudden cardiac death in young athletes, mentioning 1,101 reported cases in athletes under 35 years old between 1966 and 2004. According to these authors, ‘forty percent [of the deaths] occurred in athletes under 18 years, 33% under 16 years’. Another intriguing finding is that cycling does not feature among the three sports with the highest number of recorded deaths: they are ‘soccer (30%), basketball (25%) and running (15%)’.45 And concerning the causes, Bille et al. report that ‘underlying cardiac diseases account

92

B. Lo´pez

for approximately 90% of exercise-related sudden deaths’.46 This brings these authors to dismiss doping as a cause of sudden death as ‘unlikely’.47 It is in the light of these geographically and chronologically broader, evidence-based scientific studies that the figure of the 15 Dutch and Belgian cyclists who, according to Table 1, died of cardiac failure between 1987 and 1992, should be gauged. It is a well-established cliche´ that when one looks to data and statistics with the aim of finding a particular result, one is in serious danger of actually finding it. Therefore, shrewd researchers and commentators might discover a new ‘suspicious statistical aberration’ in the 12 deaths recorded in our research between 2003 and 2004. But it is remarkable that, after all the hue and cry surrounding the alleged 18 Dutch and Belgian victims of the late 1980s, this new ‘sudden spate of deaths’ received very limited media exposure and virtually no academic attention. The reason for this could be that only one such spate was enough to make the point about the deadly dangers of EPO.

Was EPO to blame for these deaths? The anecdotal and the scientific evidence 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 lowprofile 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.

Table 1 Sudden death of competitive cyclists in Europe between 1987 and early 2010 mentioned in the press and in cycling sites, forums and blogs. Name

Nationality

Date of death

Age

Level of practice

Cause of death

Where

1 Reinier Valkenburg 2 Ruud Brouwers 3 Connie Meijer

Dutch

4-12-1987 25 Amateur

n.a.

n.a.

Dutch Dutch

3-4-1988 n.a. Amateur 17-8-1988 25 Amateur

In bed In competition

4 Arjan de Ridder

Dutch

Summer 1989 n.a. Amateur

5 Bert Oosterbosch 6 Johannes Draaijer 7 Jef Lahaye 8 Eric Chanton 9 Leo Duynham 10 Dirk de Cauwer 11 Patrice Bar 12 Geert Reynaert 13 Adrian Hawkins

Dutch Dutch

18/08/89 32 Retired 27-2-1990 26 Professional

Dutch French Dutch Belgian Belgian Belgian British

12-4-1990 14-5-1990 26-7-1990 12-8-1990 14-9-1990 3-10-1990 20-5-1991

n.a. ‘Inflammation of the heart muscle’ Arrhythmia caused by flu and fever ‘He had serious heart rhythm disorders’; ‘had had heart surgery’ Heart stroke ‘Aorta outflow disturbance . . . had traces of an echo in his heart two weeks before his death’. n.a. Cardiac ailment n.a. n.a. Bradycardy n.a. n.a.

Retired Amateur Retired Amateur Professional Amateur Amateur

Belgian Dutch Belgian

29-10-1991 21 Amateur 13-5-1992 49 Retired 14-6-1992 24 Amateur

Belgian

16-8-1992 25 Cyclocrossman

In bed In bed

n.a. n.a. Heart failure

n.a. In competition n.a. n.a. In bed n.a. After winning a major race n.a. n.a. In competition

Cardiac ailment

In competition

Sport in History 93

14 Ju¨ rgen de Cock 15 Bart Zoet 16 Philippe Van Coningsloo 17 Wim Lambrechts

57 26 42 23 23 21 22

On beach (?)

94

Table 1 (Continued ).

18 Geert De Vlaeminck 19 Carmino Baelen

Nationality Belgian Belgian

Date of death

Age

Level of practice

9-10-1993 26 Cyclocrossman 27-10-1993 22 Cyclocrossman 5-2-1994 25 Retired

Cause of death n.a.

Where In competition

n.a.

Polish

21 Chris Cox

Belgian

22 Philippe Casado

French

21-1-1995 30 Professional

n.a.

23 Jo Leysen 24 Marc Van Meensel 25 Paul Haghedooren 26 Bjørn Stenersen 27 Glenn Fockaert 28 Kim Van Bouwel

Belgian Belgian

26-3-1995 22 Amateur 11-8-1996 26 Amateur

n.a. n.a.

During dispute at a soccer match During dispute at a rugby match In bed n.a.

Belgian

9-11-1997 38 Retired

Heart attack

n.a.

Norwegian Belgian Belgian

n.a. n.a. n.a.

In competition n.a. After a night out

29 30 31 32 33

Belgian Italian Belgian Italian French

12/09/98 28 Retired 10/03/01 20 Amateur 21/03/01 21 Cyclocrossman 29/08/02 19 Amateur 10-1-2003 32 Professional 02/03/03 19 Amateur 5-05-2003 16 Amateur 3-6-2003 23 Professional

n.a. Cardiac arrest n.a. Heart attack Cardiac arrest

In bed At the dentist n.a. In competition In bed

Johan Mannaert Denis Zanette Kenny Vanstreels Marco Ceriani Fabrice Salanson

September 1994 n.a. n.a.

‘In autumn 1990 was diagnosed with a cardiac arrhythmia and had to retire from professional cycling’ Cardiac ailment

During dispute at a soccer match

20 Joachim Halupczok

B. Lo´pez

Name

Table 1 (Continued ). Name

Nationality

Date of death

Age

Level of practice

Italian

35 Jose´ Marı´a Jime´ nez 36 Michel Zanoli 37 Marco Pantani 38 Johan Sermon 39 Alessio Galetti 40 Stive Vermaut

Spaniard

6-12-2003 32 Retired

Dutch Italian Belgian Italian Belgian

3-1-2004 14-2-2004 14-2-2004 15-6-2004 28-6-2004

41 Tim Pauwels

Belgian

42 43 44 45 46 47 48 49

Belgian Colombian Dutch Australian Belgian British Belgian Australian

Bert Heremans Ubaldo Mesa Arno Wallard Daniel Bennett Gert Verheecke Peter Bissell Fredriek Nolf James Williamson

14-11-2003 24 Amateur

35 34 21 37 28

Retired Retired Amateur Professional Retired

26-9-2004 22 Cyclocrossman 15-10-2004 25 Amateur 9-10-2004 32 Professional 28-2-2006 26 Professional 5-1- 2007 23 Amateur 5-9-2007 36 Amateur 29-12-2007 21 Amateur 5-2-2009 21 Professional 18-3-2010 26 Mountain biker

Where

Heart attack

After birthday party/ in a shopping centre Heart attack/cocaine overdose In a psychiatric hospital Cardiac arrest/suicide? n.a. ‘Acute cocaine poisoning’ In a hotel room Heart attack In bed Cardiac arrest In competition Cardiac arrest. ‘Had ended his professional career On a training ride in 2002 on the advice of his doctors, suffered a congenital heart disease’ Cardiac arrest after a fall In competition Cardiac arrest Heart failure n.a. n.a. Cardiac ailment Cardiac arrest n.a. n.a.

In competition While driving his car While training In competition After a night out In bed In bed

n.a.: not available. Source: author’s work based on an exploitation of the LexisNexis database, other online newspaper archives and cycling sites, forums and blogs. Every mention has been checked with at least two independent sources.

Sport in History 95

34 Marco Rusconi

Cause of death

96

B. Lo´pez

One of the experts most often quoted in the reviewed journalistic and academic literature is the aforementioned Randy E. Eichner, ‘a haematologist at the University of Oklahoma Health Sciences Center’.54 Eichner is arguably the author of possibly the most repeated metaphor on the dangers of EPO: if you abuse it, your ‘blood becomes mud’.55 The German current affairs magazine Der Spiegel liked it so much they used it as a title for an article on the subject: ‘Schlamm in den adern’.56 Eichner appeared to have little doubt that EPO caused a number of deaths among cyclists. The wife of Johannes Draaijer, who had died in his sleep in January 1990, stated that ‘her husband was against doping, that he was well known in the peloton as a non-user’, and that ‘the [postmortem] investigations showed nothing’ that could relate Draaijer’s death with EPO.57 But Eichner seemed to know better, as he showed no hesitation in dismissing Lisa Draaijer’s opinions as ‘just a cover-up . . . just something they’ve brainwashed her with’.58 Norman Gledhill, an exercise physiologist at York University in Toronto, also saw a conspiracy: ‘There’s either been a massive cover-up or the people who did [the investigations] were massively incompetent. I think the cover-up is the likely answer.’59 Others, such as Ed Berg, a doctor of sports medicine at the Olympic Centre, Colorado Springs, and Joseph Eschbach, a haematologist at the University of Washington Medical School, Seattle, were also quoted at that time as suspicious of the explanations provided by their Dutch counterparts.60 Such a derogative attitude towards the opinions that denied or downplayed a possible relation between these deaths and EPO could only be reasonably explained if the dismissive doctors were in possession of scientific knowledge, including a sufficient amount of empirical evidence pointing in the opposite direction. But neither Gledhill nor Eichner mention any such evidence in statements to the press. Even in Eichner’s academic papers there is a lack of substance to his arguments: For athletes abusing rEPO, this potential rise in exercising blood pressure, along with the expected rise in hematocrit61 in blood viscosity, has obvious and ominous implications. . . . Surely, the combination of high hematocrit, elevated blood viscosity, and dehydration
along with the hours on the saddle
would increase the risk of thrombosis62 in the veins of the pelvis or legs. This could lead to a fatal pulmonary embolus. These same elements, plus an accentuated rise in exercising blood pressure, may also increase the risk of stroke or, possibly, heart attack. . . . Athletes and coaches must learn this: Abusing rEPO can kill you. What price glory?63

Sport in History 97 At first sight this seems a credible explanation with some impressive closing rhetoric, but a second glance reveals that what is still missing here is empirical evidence. However, in a later article, Eichner did try to support his dramatic claims that ‘too much EPO can drive the haematocrit too high for safety by turning the blood to ‘‘mud’’ that easily clots’64 with reference to an article by Scott and Phillips, making their work potentially key to the EPO deaths case.65 These authors do indeed state that ‘hyperviscosity associated with high hematocrit levels increases the risk of thrombotic events such as stroke and myocardial infarction [heart attack]. The unexplained death of 18 otherwise healthy cyclists between 1997 and 2000 [sic] have [sic] been linked to rEPO by some sources’.66 But they also fail to quote any scientific evidence or source for these claims. Interestingly, this is not the case for other less dramatic side effects of the drug they mention, like ‘fever, nausea, headache, anxiety, and lethargy’, as well as ‘hypertension . . . in patients of hemodialysis’,67 for which they refer to an article by Denker.68 This author mentions these side effects, but he also states that ‘early studies revealed conflicting findings for increases in vascular access69 thrombosis’. Of the two sources Denker provides for this claim, one does not actually refer to vascular access thrombosis,70 while the other one, a piece of empirical research involving 79 patients during 5.25 years, demonstrated that ‘epoetin [EPO] does not increase vascular access clotting’.71 To sum up, if one goes down the chain of quotations started by Eichner himself in his 2007 article, one finds not only a lack of empirical evidence for his claims about the fatal effects of EPO, but even an article based on original research that refutes Eichner’s contention about the causal link between EPO and blood clotting, at least as far as vascular access is concerned. This lack of scientific evidence is not restricted to Eichner’s statements, though. A telling example of the poor empirical basis of the scientific claims about the health dangers of EPO can be found in an article by Deligiannis et al.,72 who contend that ‘the misuse of rHuEPO causes increased viscosity of the blood which, in combination with the elevated hematocrit, leads to increased risk of thrombosis and embolisms’. However, the source of this claim is Vergouwen et al.,73 who do not mention these side-effects in their article. According to Deligiannis et al., ‘a fatal reduction of heart rate during the night has also been reported’ as a consequence of EPO ‘misuse’,74 an allegation for which they quote Noakes.75 This author merely says the same but without providing any supporting empirical evidence or quote.

98

B. Lo´pez

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 single 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 Among these six articles, three report the most interesting conclusions for the purposes of my research. Berglund and Ekblom report that after six weeks of subcutaneous injections of EPO in 15 healthy male subjects, which raised haematocrit levels to almost 50%, blood pressure increased during exercise, but not at rest.81 This would challenge the theory that sudden death while sleeping, recorded in no less than 9 cases (see Table 1), might be due to EPO-induced hypertension. Besarab et al. studied 1,233 patients with clinical evidence of congestive heart failure or ischemic heart disease82 that were undergoing haemodialysis. One half received EPO treatment to keep their haematocrit up to 42%, while the other half received EPO just to maintain their haematocrit at 30%. The result was that the group with a higher haematocrit recorded a higher tax of myocardial infarction.83 This article refers to haemodialysis patients with structurally low haematocrits and diagnosed cardiac ailments, none of which apply to elite athletes, which makes the extrapolability of these results to healthy athletes improbable. In their experimental research involving EPO administration to healthy volunteers Stohlawetz et al. found that EPO might increase the risk of thromboembolism,84 but they state that this possibility ‘warrants further investigation’,85 that is, it is not sufficiently clear.

Sport in History 99

And finally, Wagner et al. report on their own research in which they studied the effects of chronic high haematocrit on cardiovascular functions in experimental transgenic mice. These animals, with a haematocrit of 80% (wild type: 47%) showed ‘cardiac dysfunction developed left and right ventricular hypertrophy and cardiac oedema.86 Their life expectancy was greatly reduced. . . . High hematocrit without accompanying hypoxemia87 appears sufficient to damage the heart, most likely because of the increased blood viscosity.’88 The results of this research, though, have little applicability to the case of EPO-using athletes, as their high haematocrits are not structural, occurring only at certain moments in the season when EPO is administered to coincide with major sporting events.89 Natural levels are regained when the treatment is discontinued, reaching the original values only one month after the last EPO injection.90 Counter-evidence My literature review has found 20 articles/book chapters providing counter-evidence, most of them based on original research or quoting articles based on original research, and a few based on literature reviews. These papers can be divided into two main groups: those reporting research concerning sudden death in young, competitive athletes, and those based on haematological research. None of the reviewed articles or book chapters on sudden death in young athletes91 mention EPO intake as a possible or documented cause of these deaths. In addition to the articles reviewed above concerning the prevalence of this phenomenon, Boraita quotes two research articles to sustain her claim that the main causes of sudden death in young athletes are cardiac dysfunctions and ailments, such as ‘hypertrophic cardiomyopathy . . . congenital anomalies of the coronary arteries . . . arrhythmogenic right ventricular cardiomyopathy and myocarditis’.92 According to Maron, ‘there is no evidence at present that systemic hypertension, per se, is associated with increased risk for sudden cardiac death in young athletes,93 which contradicts the theory that EPO abuse can be lethal due to an ensuing hypertension. He quotes Kaplan et al.,94 a literature review, as the source for this claim. Subirana et al., quoting several research articles, mention a number of drugs with potential adverse cardiovascular effects: ‘quinidine, phenothiazines, erythormycin and other macrolides, . . . antihistaminic drugs’ and cocaine, but not EPO.95 Based on their own research, Pluim et al. maintain that ‘the left ventricular hypertrophy in cyclists [one of the most frequent causes of sudden cardiac death],

100

B. Lo´pez

showing normal left ventricular functional and metabolic parameters, suggests physiological hypertrophy rather than a pathophysiological adaptation’. That is, it could hardly be attributed to drug/EPO intake as it is not adaptive. In their view, sudden deaths raise ‘questions about the long-term health aspects of extreme physical training’ but doping is not mentioned.96 And finally, Maron et al. conducted original research on 153 documented cases of sudden death in ‘trained athletes’ under 35 from between 1985 and 1995 in the USA. Of these, only two cases were blamed on ‘drug abuse’, the vast majority having been attributed in autopsy reports to a variety of cardiovascular ailments. They conclude that ‘sudden death in young competitive athletes usually is precipitated by physical activity and may be due to a heterogeneous spectrum of cardiovascular disease, most commonly hypertrophic cardiomyopathy’.97 The main findings of the group of articles reporting on haematological research do not support the claims concerning the alleged lethal effects of EPO use either, although it must be taken into account that none of them refer to experiments in which the ‘safe’ threshold of 50% haematocrit has been passed in humans. Lundby et al. describe an experiment involving ‘eight healthy subjects receiving 5000 IU recombinant human Epo (rHuEpo) for 15 weeks at a dose frequency aimed to increase and maintain haematocrit at approximately 50%’.98 The results show that mean arterial pressure was minimally affected by rHuEpo treatment, while cardiac output and systemic vascular conductance remained close to their pre-Epo respective values. This corroborates previous studies showing that in the range of haematocrits observed in this study (from 42 to 49%), a small increase of haematocrit has no major impact on resting mean arterial pressure and hence on systemic vascular conductance . . . this study shows that the flexibility of the red blood cells remained unchanged. Based on this, blood viscosity may be assumed to be relatively unchanged.99

Denker cites research studies by Besarab et al.100 and Abels101 to sustain the claim that ‘there is no correlation between hypertension and the rHuEPO dose or achieved hemoglobin concentrations and hypertension is not seen in rHuEPO-treated patients without renal disease’.102 As noted above, Berglund and Ekblom claim103 that blood pressure in subjects at rest remains unaltered after administration of EPO. Wagner et al., in addition to providing the evidence mentioned above supporting the theory that chronically high haematocrit damages the heart, also describe results from their experiment with transgenic mice that contradict the occurrence of some of the most often quoted alleged secondary effects of

Sport in History 101 104

EPO intake, mainly hypertension. Besarab et al. present their own research to conclude that ‘epoetin [EPO] does not increase vascular access clotting’ (see above).105 And finally, Eschbach et al. report their finding that in 333 haemodialysis patients treated with EPO, ‘there was no increase in clotting of vascular accesses’ as compared with a control group.106 Taken together, the studies cited above suggest that EPO is extremely unlikely to have had the effects that have been claimed in the speculations of anti-doping sports doctors, academics and journalists. Conclusions If the anti-doping campaign is to be seen indeed as a war, as conceived by many of its supporters, right and wrong is to be found on both sides.107 Therefore, alongside ‘doping cheats’ and ‘drug-abusing athletes’, it should not be a surprise to find as well among their persecutors some antidoping cheating and ‘doping-abusing journalism’108 and scholarship. This article aims to join other academic efforts109 in the task of uncovering and exposing some of this abuse, which has adopted the form of distortion or outright invention of historical facts that have provided ammunition for the anti-doping campaign.110 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. A total of 61 academic and journalistic texts have been reviewed that mention these deaths. My own research has recorded 17 sudden deaths among cyclists being reported in the six years between 1987 and 1992, including 9 Dutch and 6 Belgians. I have argued that, given the lack of statistical reliability of these data and the ‘Dutch and Belgian’ bias resulting from the news focus of the time and the search premises themselves, it cannot be reasonably said that they constitute a ‘suspicious statistical aberration’. But even if awarded credibility, this idea can be

102

B. Lo´pez

refuted after a comparison with data from other, statistically-based studies on sudden death in athletes. Arguably, then, what has really been going on here is a double process of invention. One invention concerns the achievement of a ‘suspicious’ statistical series of deaths through the aggregation of isolated cases from two different countries during an elastic time span. The second one consists in isolating EPO as a ‘key suspect’ on the basis that it began to be released by the time this ‘spate of deaths’ was taking place. No further evidence is brought forward other than this coincidence and the common-sense-based contention that if EPO thickens the blood, too much thick blood ‘will kill you’.112 When going into more detail, most of the experts sustaining these theories explain that EPO abuse might cause blood clotting, hyperviscosity and hypertension, which would provoke fatal heart strokes or embolisms. But the truly scientific literature, the one based on experimental case studies, reviewed in this research does not support these claims. This article displays other anecdotal evidence that rules out or downplays the possibility of EPO having caused sudden death among Dutch and Belgian cyclists in the late 1980s. All this does not mean, of course, that there is absolute proof that EPO did not contribute to the deaths of these or any other athletes, only that the existing evidence (or at least that provided by my research) does not support the contention that it did, rather the opposite. Speculation about the true goals of the anti-doping campaigners, scientists and journalists who contributed to spreading the story of the 18 Dutch and Belgian cyclists killed by EPO would be quite pointless here. A majority of them did probably little more than reproducing in all honesty stories that, after years of circulation in the media and academic discourses, had fossilized and acquired the category of fact. As for the rest, it may well be the case that they had the best intentions at heart: to save athletes’ bodies and/or souls, and to save sport’s reputation and/or purity from this new danger. But this research shows that, rather than standing on solid ground, they were in fact ‘fighting the fog’.113 As a result, what they actually achieved was, on the one hand, the creation of a fearsome, ‘silent killer’ ghost that did much to help stigmatize EPO prescription and consumption for performance-enhancing purposes. The other outcome was much more tangible: a dramatic increase in public awareness of EPO, which can safely be said to have given an enormous boost to its legal
and illegal
consumption. As Møller has aptly pointed out concerning some of the anti-doping campaigners’ tactics, ‘the road to Hell is paved with good intentions’.114

Sport in History 103

Acknowledgements The research on which this paper is based was in part conducted in Sydney, Australia, in late 2009 and early 2010 thanks to an honorary Research Visitor appointment kindly offered to the author by the Centre for Cultural Research at the University of Western Sydney. I give warm thanks to the CCR’s Director, Prof. Brett Neilson and the Centre’s efficient support staff for their hospitality and help, as well as to Prof. David Rowe for his academic guidance and friendship. I am also very grateful to Verner Møller and the members of his research group at the University of Aarhus, where I was invited to present an early version of this paper, resulting in a very fruitful discussion; to Berend Nikkels, who advised on some medical aspects of the paper; to Carme Ferre´ and Martin Hardie, who also contributed comments on an early draft of the paper; to Scott A. Escher and Jose´ Manuel Martı´nez Lage for providing a copy of their papers, and to Lucy Brzoska for undertaking the linguistic revision of the manuscript. None of them, of course, are to be held accountable for any shortcomings of the paper, for which I am solely to blame.

Notes 1. 2. 3. 4. 5. 6. 7.

8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21.

Verner Møller, The Ethics of Doping and Anti-doping. Redeeming the Soul of Sport? (London and New York: Routledge, 2010), 72. Ibid., 77. Ibid., 84. Ibid., 73. Verner Møller, ‘Knud Enemark Jensen’s Death During the 1960 Rome Olympics: A Search for Truth?’, Sport in History 25, no. 3 (2005): 452
71. Paul Dimeo, A History of Drug Use in Sport (London and New York: Routledge, 2007). Bryan E. Denham, ‘Building the Agenda and Adjusting the Frame: How the Dramatic Revelations of Lyle Alzado Impacted Mainstream Press Coverage of Anabolic Steroid Use’, Sociology of Sport Journal 16, no. 1 (1999): 1
15. Møller, The Ethics of Doping and Anti-doping, 37. Dimeo, A History of Drug Use, 55. Møller, ‘Knud Enemark Jensen’, 462. Ibid., 463. Barrie Houlihan, Dying to Win (Strasbourg: Council of Europe Publishing, 2002), 34. Dimeo, A History of Drug Use, 8. Denham, ‘Building the Agenda’, 2. Ibid., 4. Møller, The Ethics of Doping and Anti-doping, 33. Ibid. William Fotheringham, Put Me Back on My Bike. In Search of Tom Simpson (London: Yellow Jersey Press, 2003). Dimeo, A History of Drug Use. El Mundo Deportivo, August 4, 1958, cover. Ivan Waddington, Sport Health and Drugs: A Critical Sociological Perspective (London: E&FN Spon, 2000), 179.

104

22. 23.

24. 25.

26. 27. 28. 29. 30. 31. 32. 33. 34. 35.

36.

37.

38.

39. 40. 41. 42. 43.

44.

B. Lo´pez Paul Kimmage, Rough Ride (London: Yellow Jersey Press, 2007), 245. Ed Berg, a doctor of sports medicine at the Olympic Centre, Colorado Springs, quoted in William Leith, ‘Cyclists Don’t Die Like This’, The Independent, July 14, 1991, Sunday Review, 3. Waddington, Sport Health and Drugs, 179. See for instance Jesper Skibby, Skibby: Forsta˚ Mig Ret, Forfalt Til Brian Askvig (Copenhagen: Ekstra Bladets Forlag, 2006), 127, quoted in Møller, The Ethics of Doping and Anti-doping, 47. Quoted in David Powell, ‘Blood Doping Risks Revealed’, Times (London), November 14, 1990. Kimmage, Rough Ride, 246 Ibid. http://www.sportingo.com/authors/robin-parisotto, accessed March 2010. Robin Parisotto, Blood Sports: The Inside Dope on Drugs in Sport (South Yarra: Hardie Grant Books, 2004), 36. David F. Gerrard, ‘Drug Misuse in Modern Sport: Are Cheats still Winning?’, New Zealand Family Physician 32, no. 1 (2005): 7. David F. Gerrard, ‘Playing Foreign Policy Games: States, Drugs and Other Olympian Vices’, Sport in Society 11, no. 4 (2008): 461
2. Liz Clisby, ‘Drugs and the Athlete’, in Clinical Sports Medicine, 2nd edn, eds Peter Brukner and K. Khan (Sydney: McGraw-Hill, 2001), 872
99. Ibid., 873. From the following news outlets: Associated Press, Der Spiegel, El Mundo (Spain), Le Soir (Belgium), Los Angeles Times, San Francisco Chronicle, Sports Illustrated, Sunday Mail (Queensland, Australia), The Globe and Mail (Canada), The Independent, New York Times, Times, Toronto Star, Washington Post, Time and Trouw (The Netherlands). Wadler, ‘Drug Use Update’, The Medical Clinics of North America 78, no. 2 (1994); Sean Fine, James Christie and Alan Freeman, ‘Canadian Cyclist Watches Dream Die’, The Globe and Mail, November 7, 1998. W.M. Van Teeffelen, J. Pool, W.L. Mosterd, D.E. Grobbee, G.C. Van Enst, and E.G.J. Carrie`re, ‘Sudden Death and Sporting Activities’, Netherlands Journal of Cardiology 4 (1991), quoted in Else G.J. Carrie`re, Plotse Dood bij Topsport (Utrech: Nederlandse Hartstichting and Rijksuniversiteit Utrech, 1992). Pedro Manonelles, Beatriz Aguilera, Araceli Boraita, Emilio Luergo, Carlos Pons and M. Paz Sua´ rez, ‘La Muerte Su´ bita en el Deporte. Registro en el Estado Espan˜ ol’, Apunts. Medicina de l’Esport 153, no. 2 (2007): 27. It is noteworthy that an official registry of sudden death in athletes was only set up in Spain in 1995. Manonelles et al., ‘La Muerte Su´ bita’, 29. Ibid. Author’s own translation from Spanish. B.J. Maron, ‘Sudden Death in Young Athletes’, New England Journal of Medicine 349, no. 11 (2003): 1064
75. B.J. Maron, J.J. Doerer, T.S. Haas, D.M. Tierney, and F.O. Mueller, ‘Sudden Deaths in Young Competitive Athletes. Analysis of 1866 Deaths in the United States, 1980
2006’, Circulation 119, no. 8 (2009): 1085
92. Ibid., 1088.

Sport in History 105 45.

46. 47. 48.

49.

50.

51.

52.

53.

54.

55. 56. 57.

Karin Bille, David Figueiras, Patrick Schamasch, Lukas Kappenberger, Joel I. Brenner, Folkert J. Meijboom and Erik J. Meijboom, ‘Sudden Cardiac Death in Athletes: the Lausanne Recommendations’, European Journal of Cardiovascular Prevention & Rehabilitation 13, no. 6 (2006): 859. Ibid., 868. Ibid. Leith, ‘Cyclists Don’t Die Like This’; Jere Longman, ‘Backtalk; Lifesaving Drug Can Be Deadly When Misused’, New York Times, July 26, 1998, available at http://www.nytimes.com/1998/07/26/sports/backtalk-lifesaving-drug-can-be-deadlywhen-misused.html?pagewanted1, accessed March 2010. According to most of the reviewed academic articles, death would be a direct consequence of blood turning into ‘mud’, ‘ketchup’, ‘oil’, ‘yogurt’ or ‘sludge’, to use only some of the dramatic expressions one can find in the reviewed literature, as a more or less immediate consequence of EPO intake, one which would quickly disappear once the effects of the drug had faded. This interpretation, however, might be challenged if one considers that athletes could be using the drug during the off-season for experimentation purposes (my thanks to Erkki Vetenniemi for raising this point). Between $4,000 and $6,000 in the US for a year’s treatment and 50% more in Europe, according to Daniel Vapnek, senior vice-president of Amgen, the American manufacturer of the drug, quoted in Powell, ‘Blood Doping Risks Revealed’. Another source mentions a cost of between US$5,000 and 10,000 (Michael Specter, ‘Supermen on New Blood Drug Endanger Sports and Themselves’, Washington Post, 2 April, 1990). For a convincing discussion of why amateur riders are not prone to doping themselves see Ask Vest Christiansen, ‘A Clean Amateur Makes a Good Professional: On Deviance, Professionalism and Doping in Elite Sport
Illustrated by the Case of Danish Cycling’, http://www.doping.au.dk/file admin/INHDR/Ask_Vest_Christiansen_-_A_Clean_Amateur_Makes_a_Good_ Professional.pdf, accessed March 2010; and Christophe Brisonneau, L’E´preuve du Dopage (Paris: Presses Universitaires de France, 2008). Patrice Bar was in his first year in the professional ranks. Neo-professionals are very seldom paid the high salaries of the stars that are needed to afford the most expensive doping products, especially concerning the period and the drug under discussion. The same can be said of most cyclo-cross riders. Erythrocytosis, also known as polycythemia, consists in an excess of erythrocytes, or red blood cells. Wolfgang Jelkmann, ‘Beneficial and Adverse Effects of Erythropoietin Therapy’, in Biomedical Side Effects of Doping, eds Christiane Peters, Thorsten Schulz and Horst Michna, (Ko¨ ln: Verlag Sport und Buch Strauß, 2002), 37, available at http://www.lrz-muenchen.de/ tc131ac/ webserver/webdata/data/buchbseod.pdf, accessed March 2010. Merrell Noden, ‘A Bad Boost’, Sports Illustrated, November 26, 1990, available at http://sportsillustrated.cnn.com/vault/article/magazine/MAG1136132/1/index. htm, accessed March 2010. Quoted in ibid. Der Spiegel, June 10, 1991, 191. Leith, ‘Cyclists Don’t Die Like This’.

106

58. 59. 60. 61. 62. 63. 64. 65. 66. 67. 68. 69. 70.

71.

72.

73. 74. 75. 76.

77.

B. Lo´pez Quoted in ibid. Fine, Christie and Freeman, ‘Canadian Cyclist Watches Dream Die’. Leith, ‘Cyclists Don’t Die Like This’. Hematocrit or haematocrit, also known as ‘packed cell volume’ (PCV), is the proportion of blood volume that is occupied by red blood cells. The formation of a blood clot inside a vessel, obstructing the flow of blood. E.R. Eichner, ‘Sports Anemia, Iron Supplements, and Blood Doping’, Medicine & Science in Sports & Exercise 24, no. 9 (1992): S317. E.R. Eichner, ‘Blood Doping: Infusions, Erythropoietin and Artificial Blood’, Sports Medicine 37, no. 4
5 (2007): 390. J. Scott and G.C. Phillips, ‘Erythropoietin in Sports: A New Look at an Old Problem’, Current Sports Medicine Reports 4 (2005): 224
6. Ibid., 225. Ibid. B. Denker, ‘Erythropoietin: From Bench to Bedside’, Nephrology Rounds 2, no. 3 (2004). The methods used to gain access to the blood in patients of hemodialysis. R.W. Evans, B. Rader, D.L. Manninen, and the Cooperative Multicenter EPO Clinical Trial Group, ‘The Quality of Life of Hemodialysis Recipients Treated with Recombinant Human Erythropoietin’, Journal of the American Medical Association 263, no. 6 (1990): 825
30. A. Besarab, F. Medina, E. Musial, N. Picarello and H. Michael, ‘Recombinant Human Erythropoietin does not Increase Clotting in Vascular Accesses’, ASAIO Transactions 36, no. 3 (1990): 749
53. Asterios Deligiannis, Hans Bjo¨ rnstad, Franc¸ ois Carrec, Hein Heidbu¨ chel, Evangelia Kouidi, Nicole M. Panhuyzen-Goedkoop, Fabio Pigozzi, Wilhelm Scha¨nzer and Luc Vanhees on behalf of the ESC Study Group of Sports Cardiology, ‘ESC Study Group of Sports Cardiology Position Paper on Adverse Cardiovascular Effects of Doping in Athletes’, European Journal of Cardiovascular Prevention and Rehabilitation 13 (2006): 687
94. C. Vergouwen, T. Collee and J.J. Marx, ‘Haematocrit in Elite Athletes’, International Journal of Sports Medicine 20 (1999): 538
41. Deligiannis et al., ‘ESC Study Group’, 690. T.D. Noakes, ‘Tainted Glory. Doping and Athletic Performance’, New England Journal of Medicine 151 (2004): 848. For instance, Tokish, Koche and Hawkins state that ‘raising one’s hematocrit beyond physiologically normal levels leads to an increase in blood viscosity, thrombogenic potential [risk of generating clots inside a blood vessel], and myocardial infarction risk’: John M. Tokish, Mininder S. Kocher, and Richard J. Hawkins, ‘Ergogenic Aids: a Review of Basic Science. Performance, Side Effects, and Status in Sports’, American Journal of Sports Medicine 32, no. 6 (2004): 1543
53. The source these authors provide as the basis for this claim is J. Ramotar (‘Cyclists’ Deaths Linked to Erythropoietin?’, The Physician and Sportsmedicine 18 (1990): 48
9), who quotes Eichner, without mentioning any further empirical evidence. V.S. Cowart, ‘Erythropoietin: A dangerous New Form of Blood Doping’, The Physician and Sportsmedicine 17 (1989): 115
18; Ramotar, ‘Cyclists’ Deaths Linked’.

Sport in History 107 78.

79. 80.

81.

82. 83.

84.

85. 86. 87. 88.

89. 90.

91.

Jose´ Manuel Martı´nez Lage, Carlos Panizo, Jose´ Masdeu and Eduardo Rocha, ‘Cyclist’s Doping Associated with Cerebral Sinus Thrombosis’, Neurology 58 (2002): 665. Ibid. S.W. Stack and S.A. Berger, ‘The Effects of High Hematocrit on Arterial Flow
A Phenomenological Study of the Health Risk Implications’, Chemical Engineering Science 64, no. 22 (2009): 4701
6. B. Berglund and B. Ekblom, ‘Effect of Recombinant Human Erythropoietin Treatment on Blood Pressure and Some Haematological Parameters in Healthy Men’, Journal of Internal Medicine 229, no. 2 (1991): 125. Ischemia consists in a restriction in blood supply resulting in damage or dysfunction of tissue. A. Besarab, W.K. Bolton, J.K. Browne, J.C. Egrie, A.R. Nissenson, D.M. Okamoto, S.J. Schwab and D.A. Goodkin, ‘The Effects of Normal as Compared with Low Hematocrit Values in Patients with Cardiac Disease who are Receiving Hemodialysis and Epoetin’, New England Journal of Medicine 339, no. 9 (1998): 584. J. Stohlawetz, L. Dzirlo, N. Hergovich, E. Lackner, C. Mensik, H.G. Eichler, E. Kabrna, K. Geissler and B. Jilma, ‘Effects of Erythropoietin on Platelet Reactivity and Thrombopoiesis in Humans’, Blood 95, no. 9 (2000): 2983. Ibid., 2988. Oedema is an abnormal accumulation of fluid in any given part of the body. Hypoxemia consists in a decreased partial pressure of oxygen in blood. K.F. Wagner, D.M. Katschinski, J. Hasegawa, D. Schumacher, B. Meller, U. Gembruch, U. Schramm, W. Jelkmann, M. Gassmann and J. Fandrey, ‘Chronic Inborn Erythrocytosis leads to Cardiac Dysfunction and Premature Death in Mice Overexpressing Erythropoietin’, Blood 97, no. 2 (2001): 542. Willy Voet, Breaking the Chain. Drugs and Cycling: The True Story (London: Random House, 2002). K.I. Birkeland, J. Stray-Gundersen, Hemmersbach, Jostein Halle´ n, Egil Haug and Roald Bahr, ‘Effect of rhEPO Administration on Serum Levels of sTfR and Cycling Performance’, Medicine and Science in Sports and Exercise 32, no. 7 (2000): 1240. Maron et al., ‘Sudden Deaths in Young Competitive Athletes’; Manonelles et al., ‘La Muerte Su´ bita’; Bille et al., ‘Sudden Cardiac Death’; Maron, ‘Sudden Death in Young Athletes’; Araceli Boraita, ‘Sudden Death and Sport. Is There a Feasible Way to Prevent it in Athletes?’, Revista Espan˜ ola de Cardiologı´a 55, no. 4 (2002): 333
6; B.J. Maron, ‘Cardiovascular Causes and Pathology of Sudden Death in Athletes: The American Experience’, in Arrhythmias and Sudden Death in Athletes, eds A. Baye´ s de Luna, F. Furlanello, B.J. Maron and D. Zipes (Dordrecht: Kluwer Academic Publishers, 2000), 31
44; M.T. Subirana, R. Elosua, X. Vin˜ olas P. Ferre´ s, T. Baye´ s-Genı´s, J. Guindo, T. Martı´nez-Rubio and A. Baye´ s de Luna, ‘Markers and Triggers of Sudden Death in Athletes’, in Arrhythmias, eds A. Baye´ s de Luna, F. Furlanello, B.J. Maron, P.P. Zipes; B.J. Maron, J. Shirani, C. Liviu, C. Poliac, R. Mathenge, W.C. Roberts and F.O. Mueller, ‘Sudden Death in Young Competitive Athletes: Clinical, Demographic and Pathological Profies’, Journal of the American Medical Association 276, no. 3 (1996): 199
204; B.M. Pluim, J.C. Chin, A. De Roost, J. Doornbost, H.-M. J.

108

92. 93. 94. 95. 96. 97. 98.

99. 100. 101.

102. 103. 104. 105.

106.

107. 108.

109. 110.

B. Lo´pez Siebelink, A. Van der Laarse, H.W. Vliegen, R.M.J.N. Lamerichs, A.V.G. Bruschke and E.E. Van der Wall, ‘Cardiac Anatomy, Function and Metabolism in Elite Cyclists Assessed by Magnetic Resonance Imaging and Spectroscopy’, European Heart Journal 17 (1996): 1271
8; and N.M. Kaplan, R.B. Deveraux and H.S. Miller, Jr., ‘26th Bethesda Conference: Recommendations for Determining Eligibility for Competition in Athletes with Cardiovascular Abnormalities. Task Force 4: Systemic Hypertension’, Journal of the American College of Cardiology 24, no. 4 (1994): 885
8. Myocarditis is the inflammation of the heart muscle. Maron, ‘Cardiovascular Causes’, 41. Kaplan, Deveraux and Miller, ‘26th Bethesda Conference’. Subirana et al., ‘Markers and Triggers’, 84. Pluim et al., ‘Cardiac Anatomy’, 1277. Maron et al., ‘Sudden Death’, 1277. Carsten Lundby, Jonas Juhl Thomsen, Robert Boushel, Maria Koskolou, Jørgen Warberg, Josse´ A.L. Calbet and Paul Robach, ‘Erythropoietin Treatment Elevates Haemoglobin Concentration by Increasing Red Cell Volume and Depressing Plasma Volume’, Journal of Physiology 578, no. 1 (2007): 309. Ibid., 313 (emphasis added). Besarab et al., ‘Effects of Normal’. R.I. Abels, ‘Use of Recombinant Human Erythropoietin in the Treatment of Anemia in Patients Who Have Cancer’, Seminars in Oncology 19, n. 3, suppl. 8 (1992): 29
35. Denker, ‘Erythropoietin’, no page numbers provided (emphasis in original). Berglund and Ekblom, ‘Effect of Recombinant’. Ibid., 541. A. Besarab, F. Medina, E. Musial, N. Picarello and H. Michael, ‘Recombinant Human Erythropoietin Does Not Increase Clotting in Vascular Accesses’, ASAIO Transactions 36, no. 3 (1990): 749
53. J.W. Eschbach, M.H. Abdulhadi, J.K. Browne B.G. Delano, M.R. Downing, J.C. Egrie, R.W. Evans, E.A. Friedman, S.E. Graber, N.R. Haley, S. Korbet, S.B. Krantz, A.P. Lundin, A.R. Nissenson, D.A. Ogden, E.P. Paganini, B. Rader, E.A. Rutsky, J. Stivelman, W.J. Stone, P. Teschan, J.C. Van Stone, D.B. Van Wyck, K. Zuckerman and J.W. Adamson, ‘Recombinant Human Erythropoietin in Anemic Patients with End-stage Renal Disease: Results of Phase III Multicenter Clinical Trial’, Annals of Internal Medicine 111, no. 12 (1989): 992. Dimeo, A History of Drug Use. Ask Vest Christiansen, ‘The Doping Abusing Journalist’, available at http:// www.playthegame.org/take-part/home.html?tx_wecdiscussion[show_date] 093006&tx_wecdiscussion[archive]  1, accessed March 2010. Denham, ‘Building the Agenda’; Møller, ‘Knud Enemark Jensen’; Dimeo, A History of Drug Use. As an example of the strategic interest of anti-doping in propaganda, the Italian campaigner Sandro Donati shows fondness for having contributed to triggering ‘the press campaign’ involving ‘many Italian and international newspapers’ that contacted him after the scandal surrounding a report on doping he delivered to the Italian Olympic Committee. ‘After so many years of struggle’, Donati ‘knew how to manage’ this campaign: Alessandro Donati,

Sport in History 109

111. 112. 113. 114.

‘The Silent Drama of the Diffusion of Doping among Amateurs and Professionals’, in Doping and Public Policy, eds J. Hoberman and V. Møller (Odense: University Press of Southern Denmark, 2004), 50. Dimeo, A History of Drug Use, 110. Eichner, quoted in ‘Doctor Issues Drug Warning’. The Globe and Mail, 3 November, 1990. Møller, The Ethics of Doping and Anti-doping, 12. Ibid.