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EPO Drug Testing Q&A
Sept. 11, 2003-

The track and field world has been rocked the last couple of weeks by a few drug scandals. Much of the press' attention has been on the Kelli White and Jerome Young cases, but the biggest news to our viewers without a doubt has been the positive drug test for EPO by Bernard Lagat of Kenya (for more on the positive test click here). Lagat, the second-fastest 1500 meter runner of all-time and the Sydney Olympics bronze medallist, had his "A" sample come back positive for EPO. If his "B" sample comes back positive and he is determined to have committed an EPO doping offense, he will be the first Kenyan male runner to have been busted for using blood boosting drugs.

Lagat's preliminary positive EPO test sent shockwaves throughout the track and field community and people all across the globe are speculating a lot not just about Lagat, but also about the overall prevalence of drug abuse in the higher echelons of track and field. Much of the speculation is just that speculation, as many people don't really know how the EPO test works and how the whole drug testing process really works.

As a result, we contacted Dr. Don Catlin one of the preeminent drug testing researchers in the world to help clarify for ourselves and our web-site viewers what goes on with an EPO test. Dr. Catlin heads the UCLA Olympic Analytical Laboratory, one of the top drug labs in the world, and he headed the drug testing lab at the 2002 Salt Lake City Olympics. Although Dr. Catlin did not develop the urine test for EPO detection, his lab is one of 6 in the world, as of March 2003, accredited to perform the test. Currently his lab is doing work on improving the EPO test, by trying to increase the tests retrospectivity (how far back in the past the test can detect EPO use). At the Salt Lake City Olympics, Dr. Catlin perhaps was most well known for having led the team that developed the test for darbepoetin, a new performance enhancing drug very similar to EPO that athletes thought there was no test for. (For more info on the darbepoetin positives at the Salt Lake Olympics and how Dr. Steve Elliott, the man who developed darbepoetin for the pharmaceutical giant Amgen, provided crucial testimony before the Court of Arbitration for Sport supporting Dr. Catlin's work, click here. Dr. Catlin calls Dr. Elliott a "real hero" for his testimony that helped lead to two medallists in the Olympics being stripped of their medals for doping offenses.)

The conversation we had with Dr. Catlin was very informative.  We now present to you some of the results of our conversation with Dr. Catlin, coupled with our own research into EPO and drug testing in general, to hopefully answer many of the common questions you may have about EPO and drug testing.  Far too many anti-drug crusaders (including ourselves), have never really truly understood how the process works.

1) EPO is a naturally occurring substance in the body. Could an athlete who lives at altitude or has great genetics and thus might have more EPO in their body naturally than a normal person, test positive for EPO?

No. Currently, to be convicted of an EPO offense athletes must test positive for EPO with the urine EPO test. The urine EPO test is not an indirect test that detects unusually high EPO levels. Rather, it is a direct test that detects the actual presence of recombinant EPO (EPO from a source outside the body).  Thus, it would be foolish for an athlete to argue that the test was just showing a naturally high level of natural EPO.  As Dr. Catlin said to us, with the urine EPO test the testers "see a footprint of the (recombinant EPO) molecule". The World Anti-Doping Report of March 11, 2003, evaluating the urine EPO test concluded, "the urine EPO test is the only existing test to directly evaluate and prove the EPO abuse of athletes"

2) I've heard a lot about using both a blood and urine test to detect EPO use. Doesn't an athlete have to test positive for EPO on both the blood and urine test to be considered a doper?


Blood testing has received a lot of attention because it is a new concept in the drug testing world. There is a blood test for EPO use, but it is only an indirect test that can be used as a screening measure to save money by determining whether the urine EPO test needs to be conducted. All the blood test does is tell the testers that the athlete has an unusual blood profile that warrants further investigation.  The abnormal profile could be caused by the use of EPO, some other blood boosting drug, or just be explained by the athlete being a genetic freak or living at altitude. The testers then perform the urine EPO test to determine whether artificial EPO is the cause of the abnormality.

The blood test does not have to be done in order for the athlete to test positive for EPO.  

3) If the blood test doesn't have to be performed, then why does it exist? Not only do you say it is unnecessary, but it seems quite invasive and expensive to test athletes' blood when a simple urine test could be done.

Believe it or not, the blood EPO test is much cheaper than the urine EPO test. The blood test costs somewhere in the ballpark of $60, whereas the urine test costs approximately $400 per test. The reason for this is that conducting the urine EPO test takes up a lot of the time of the technicians in the lab (sometimes up to two or three days) . Thus, the blood urine test can be used in situations to save money.  

If would be very expensive to conduct a urine EPO tests on all athletes at $400 a pop. Thus the blood EPO test can be used to determine which athletes are most likely to be on EPO, and then the urine EPO test can be administered on this smaller sub sample.

For example purposes only, assume there are 100 athletes and only 1 has used EPO. It would cost $40,000 ($400 *100=$40,000) to test all of them for EPO using the urine EPO test. Instead if the blood test can be used on all the athletes to determine which 10 athletes are most likely to be EPO users, then the expensive urine test can be administered on the 10 suspect athletes and a lot of money can be saved.  Combining the blood and the urine test only costs $10,000 ($60*100= $6,000 for the blood test on all the athletes and then 10 * $400= $4000 for the urine test on the 10 suspect athletes).Thus in this hypothetical example, using both the blood and urine test together would save approximately $30,000 as the blood and urine test combination costs only $10,000 versus the $40,000 it would cost to do the urine test on all the athletes.

4) Are you positively sure about the blood EPO test being unnecessary? Didn't Olga Yegerova get her positive EPO test in 2001 thrown out because a blood test wasn't done?

Yes we're sure the blood test isn't necessary and yes she did get the test thrown out because a blood test wasn't done. But let us explain. When the EPO testing was done in Sydney the protocol was to do the blood testing to first screen the samples and then use the urine test to actually test for EPO. It took a while for the scientific community and the sports federations to finally agree that the urine test in itself was the only test necessary for a positive EPO test. In 2001, Yegerova's urine tested positive and the French accepted this as conclusive proof of a positive test, but the IAAF still insisted that a blood test was needed (her blood had not been taken so a blood test could not be done) as well even though in reality the blood test is only used as a screening device and not necessary for a positive test. Ironically, when Yegerova's blood was screened at the World Championships a few weeks later, her blood sample came back as suspicious, but the urine test did not show EPO usage (remember the urine EPO test can often only detect EPO usage in the previous 48 hours).

5) What about an athlete testing falsely positive? Isn't that a possibility.

It's highly, highly unlikely if proper procedures are carried out. As Dr. Catlin said the urine test is "a very solid test." Only 6 labs in the world as of this past March carried out the EPO test.  Dr. Catlin said, "I don't know how other labs do it (the exact procedures they use in carrying out the test), but we don't call a test positive unless we're absolutely sure".  In addition, the March 2003 WADA report evaluating the urine EPO test stated "in its normal use, this test, apparently, has never been found to give false positive results". The test when implemented correctly has a safety margin built in to prevent false positives.  Plus remember, in addition to the test being very sound, athletes have 2 samples tested (an "A" and a "B" sample) that both must comeback positive before an athlete is determined to have committed a doping offense. At this stage, only Mr. Lagat's "a" sample has come back positive. He will be entitled to have his own representatives present to ensure proper protocols are followed when his "b" sample is tested in the time intensive urine EPO testing process.

Remember the urine EPO test when properly administered is a test for direct proof of recombinant EPO. Often in the press, we read about athletes having drug tests over turned for not being conclusive, but often times this is when indirect evidence (say a high T/E ratio) is used to determine a drug positive.

6) How effective is the urine EPO test? Won't the drug cheats always be figuring out ways to beat the test?

The bad news is that the urine EPO test currently doesn't detect EPO usage very far back in time. Dr. Catlin noted that how effective the test is in detecting past EPO use is highly variable and depends on the dose of EPO the person is taking, their metabolism and other factors. It is common for the urine test to only detect EPO use in the last 48 hours but for some individuals the test can detect EPO use up to 6 or 7 days in the past. Around 100 athletes at the Salt Lake Olympics who had abnormal values from the blood EPO test (indicating that they were possibly doping), passed the urine EPO test. Presumably some or many of these 100 athletes were dopers, but passed the urine EPO test only because currently the urine EPO test can only detect very recent EPO use. As Dr. Catlin said in the March 20, 2002, Washington Post about these 100 suspicious people, "My guess is that we were looking at people who had used, but their urine [sample] turned up negative because EPO goes away very fast."

The good news is researches are slowly making the urine EPO test more effective (so it will go back farther in time looking for EPO usage) and less expensive. The bad news is it costs a lot of money to do the scientific research to make the tests more effective and the anti-doping researchers are vastly underfunded according to Dr. Catlin. Oftentimes in the press the anti-drug crusade is presented as a futile exercise where the cheats will always be ahead of the testers. But according to Dr. Catlin, the main reason the testers are always behind the drug cheats is because a lack of funding.

As he said, "The main frustration I have is that we could be ahead (of the drug cheaters) all the time, but it takes money." Ultimately he is convinced that there is enough money within world sport to combat the drug problem but it is a matter of convincing people in sport to spend the money on drug testing and research. "If they want to solve the problem (of drugs in sport) they will. But I'm not sure it's going to happen."

In the next few days, we'll follow up with the second part of our drug testing report which will give a lot of insight into just how much money Dr. Catlin thinks would be necessary to wipe out the drug problem in sport (We bet it's not as high as you think).  Until then, we will note that Dr. Catlin, a veteran drug tester and researcher who has been in the business for over two decades, says he doesn't have "a lot of optimism" that sport will commit the necessary funds.

If you'd like to read about the darbepoetin positives at the Salt Lake Olympics click here.

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