Watched Pantani: Accidental Death of a Cyclist last night, a couple questions

We will never know how many of them died because of heart problems caused by viral infection, genetics or drugs. We can only guess.

Just to reframe briefly the main claims of my latest and confusing post (if there exists a single follower in this thread):

1) There was a lot of gossip about EPO use from the moment the product was introduced in 1986-1987. This must've started speculations about its use whenever there was a sudden improvement in anyone's performance.

2) The logic that EPO found its ways into sports already in 1986 during the first clinical trials could be based on the hypothesis that as EPO started causing deaths in 1987, it must've been available. If some other factor killed the cyclists, that would pretty much ruin the whole argument.

3) Apparently the product didn't find its way into cross country skiing in 1989, and as late as 1992 some teams were using old school transfusions.

One could also point to the fact that there are zero confessions from 1980s whereas several cyclists have admitted that they had started taking the drug somewhere around 1992-1993.

So, if everyone in this thread seems to believe doping is still prevalent, then- at what cycling level are the athletes still clean?

Question then? wrote:

So, if everyone in this thread seems to believe doping is still prevalent, then- at what cycling level are the athletes still clean?

I'm wondering this too about cycling as well as running. I wonder if peds have found their way down to the amateur level. Anyways, I want to thank Aragon for posting in this thread. His knowledge and insights have served to open my eyes.

These are all reasonable points, Aragon. I agree that anyone claiming that we "know" that EPO caused a bunch of deaths in the late 1980s and early 1990s is overstating the case.

That said, I think there's a risk of a "Type II error" (i.e. false negative) in assuming that the absence of definitive evidence means that it definitely didn't happen (which is what a growing number of people, particularly cycling insiders, have been claiming). A lack of autopsy evidence and a lack of confessions are precisely what you'd expect under the circumstances, whether it did or didn't happen. The people who may have tried EPO in the 1980s have avoided being implicated; why would they confess now, particularly when its use at that time is linked (rightly or wrongly) to deaths?

Kimmage's series on Draaijer made it a near-certainty (to my mind) that he was on drugs of some sort. Of course, when he goes to see Krikke, Krikke doesn't reveal anything. Even if it could be proven that Draaijer was on EPO (which certainly hasn't been proven), that wouldn't establish a link between his use and his death. The evidence that critics seem to want -- proof that EPO directly caused the deaths -- wouldn't exist even if it happened.

So what are we left with? A pattern of deaths among a certain demographic in a certain geographic area at a certain time that subsequently stopped. My level of suspicion regarding EPO's role in at least some of those deaths remains high.

I'll admit that you do have several good points. In the end, the EPO-connection was impossible to prove if it indeed existed. There was no test for EPO and there is the possibility that the official inquiry wasn't certain what to look when investigating the deaths. Without debating about questionable motives of participants, if for the sake of the argument we assume that there was EPO available from the trials and the official inquiry wasn't good at all, it would be more fruitful to take a deeper look at who these death cyclists actually were.

In his pretty well-known 2011 revisionist paper, Spanish scholar Bernat López does just this and gathers a list of the sudden deaths of cyclists from online newspaper archives, forums, discussion boards etc.

http://www.tandfonline.com/action/downloadTable?id=T0001&doi=10.1080%2F17460263.2011.555208&downloadType=PDF

First thing that catches the attention is that there isn't close to twenty deaths of Dutch cyclists in 1987-1990, so it should be emphasized that while it does have the most famous and successful cyclists, both amateurs and pros, the list is far from complete. Most likely those roughly 10 not on the list were either retirees or lower level amateurs as their deaths were hardly reported in media.

Aside from some slight sloppiness (see the last paragraph), López still makes an interesting and very sound conclusion regarding the deaths: almost all the people in the list are either

- retirees (no motive to use EPO)

- amateurs (low financial resources + non-existent access to EPO at that period)

- or the deaths occurred outside the competitive season (except for experimental purposes no reason to waste difficult-to-obtain-product).

On the issue of amateurs, it should be pointed out that the assumed EPO available was from very questionable (=illegal?) sources and that professionals of most countries apparently didn't have access to these expensive supplies. The availability increased noticeably when Swiss Pharmaceutical company Cilag made its brand name EPREX (apparently known as Erypo 2000 in Germany) available in summer 1989. My impression is that you needed at first a prescription in Switzerland, but quickly it became at least "de facto" OTC drug.

If one would believe the most orthodox narrative (apparently you do not), Dutch amateurs were dying in 1987 because of EPO, whereas very doping-innovative professional team PDM had to use messy and risky transfusions in 1988 Tour de France next year.

A few words on the missing names in the López-list, if anyone is interested. A 1991 article in The Observer mentions additionally in passing these names: 1987 (Kees Evers, Harry van Pierre); 1988 (Gerard Ratterman); 1989 (Willem Paardekooper, Piet Steenvoorden). Evers was a 25-year old amateur and Ratterman 33-years old (not sure whether an amateur and one source mentioning that he died in a traffic accident), the rest three being 40+ (semi)retirees. Belgian cycling pro Geert Van de Walle (11/1988, 23 years) is not also on the list (died out of competitive season).

Yes, López's paper is one of the ones I find most... over-the-top in its dismissal of the claims. He's clearly and strongly arguing one side of the debate rather than trying to evenly weigh both sides. That's understandable, given that his view is (or was) a minority position, but it still results in a not-very-balanced look at the issues.

Aragon wrote:

López still makes an interesting and very sound conclusion regarding the deaths: almost all the people in the list are either

- retirees (no motive to use EPO)

- amateurs (low financial resources + non-existent access to EPO at that period)

- or the deaths occurred outside the competitive season (except for experimental purposes no reason to waste difficult-to-obtain-product).

It's admittedly circumstantial to argue that "EPO became available in the late 1980s, a bunch of riders died in the late 1980s, therefore EPO killed them." It's just as circumstantial to argue that a death that occurred in an amateur or in the off-season couldn't possibly be linked to EPO.

Personally, if I was considering trying a new and relatively untested drug to boost my performance, I wouldn't do it in the middle of my competitive season. I'd first try it out outside of the main competition season. And what does off-season mean, anyway? Do we know the riders weren't training, or was it simply a time when they weren't competing?

As for amateur status, there are plenty of people in the world who have money to spare regardless of whether they're professional athletes (from their main job, from family, etc.). And there are plenty of amateurs who dream of being professionals.

As an aside, Draaijer is a perfect example of someone who may have had a pre-existing heart condition (identified in cardiac screening a few weeks before he died, if I'm recalling correctly). These sorts of findings should not be weighed too heavily. Cardiac screening produces a huge number of "abnormal" findings -- typical false-positive estimates are in the 10-40% range (http://circ.ahajournals.org/content/115/12/1643.full). It certainly possible that he (and others) had some sort of heart condition that led to his death, but the fact that his cardiac screening turned up an abnormality isn't at all unusual.

López admits that he comes from the ”revisionist” (Dimeo-Moller)-tradition, so I would read his paper with extra skepticism. For instance, reader is easily left with the impression that there were only seven Dutch deaths in 1987-1990 and if I am not mistaken, he even calculates the number of deaths/year from this figure. For him it shouldn't have been a too great task to contact the Dutch Cycling Union (who did the inquiry on the deaths) for some further information on the issue. And I am also not fully convinced about his claims that EPO isn't dangerous althought even there might be something more than is usually told.

In the end, I still think that his main approach into the issue of the circumstances of the deaths is very sound.

On the OFF-season issue, it could be said that cyclists haven't usually kept their hematocrit up all around the year. Matt Rendell's Pantani-biography tells that Pantani had his hematocrit elevated from 40-42 to 56-60 from January to July in both 1994 and 1995. Perhaps Pantani put a lot of weight to Giro and Tour and while someone else could've had other preferences, still October-March period is mostly for exercising and there are hardly any notable cycling races at that time period.

Very plausible assumption. But a few things should be taken into consideration.

First, the mechanism of EPO (elevated hematocrit) is identical to that of old-school blood doping, so the substance necessarily didn't need to be tested as the mechanism of blood doping was pretty much proven to work by late 1980s.

But if we assume that EPO would be tried in out-of-competition season, most likely it would be to test whether body reacts to the injections at all. Here some quasi-scientific math on the issue. Just a few random calculations of this chart tells that it took somewhere around 30000-90000 IUs of EPO to elevate hematocrit by 4-7 percentage points.

It would take up to several weeks and a large amount of EPO to reach the dangerous hematocrit levels of 60+. The response to EPO is somewhat individual and maybe you could circumvent the timespan problem with megadosing (assuming anyone wanted to megadose "a new and relatively untested drug"), but it still doesn't sound too plausible scenario that someone would use up to dozens and dozens of stolen and most likely expensive black market ampoules to just to try the product (NYT (5/19/91) photo of first Epogen-ampoules says ”3000 IU”). While EPO became more cheap and easily accessible in 1990s, so became the knowledge on its effect, so the rationale to training season experiments diminished.

To get hold of EPO in pre-Eprex days took more than ambition and money – connections. The world of late 1980s was full of amateur cyclists with money and professional teams with questionable ethics, but apparently even most of them didn't know how to get an access to the mysterious black market underworld of EPO so it is very unlikely that amateurs of one country could've done this particularly when there is nothing about Netherlands that links the country to the clinical trials where the drugs apparently came.

The debate about Draaijer and heart conditions is easily in the dead end, but easily gets the impression that at least something questionable was going on (particularly when he had a history with PDM team). Everything could be "possibly" linked to EPO, but at the end of the day, the story is about statistical odds because practically everything is cirmumstantial. While there was a moral panic about a cluster of deaths after three famous Dutch cyclist (Meijer, Oosterbosch, Draaijer) died in a timespan of only 18 months, for reasons I've outlined in all of my posts, the statistical odds aren't too high that EPO had much anything to do with the phenomenom assuming that there was a statistically unusually high amount of deaths in the first place.