No denying the seriousness of malaria. However Canova did not seem to think that taking medication to prevent malaria was particularly useful:
http://www.letsrun.com/forum/flat_read.php?thread=4575000&page=2
Quote from his post:
"One example : the most part of people coming Kenya follow a lot of profhylaxis against yellow fever, malaria, colera, typhus and other diseases. Result ? Many of them become sick, because all the vaccinations make them very weak. I live in Kenya 8 months per year, I came here in 1998, AND NEVER GOT ANY MEDICINE. And, of course, I never had any problem.
Try to return to a more natural approach, avoiding any idea of drugs not only in sport, but in your life, and you can become more quiet and your life become better."
Read more: http://www.letsrun.com/forum/flat_read.php?thread=4575000&page=2#ixzz45DxNRieO
Scientists & doctors please chime in - Is EPO a prescription given to malaria patients as a 2:05 marathoner claims?
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I'm a scientist who often works in rural tropical areas. I've had malaria and it's not fun, but I never take drugs to prevent malaria. You just can't take it all the time. The local people don't take it. If you do one short-term trip to a malaria area, it's probably good to take something, but I'd be on it continuously and I don't want to do that.
I didn't read through the thread, but this is the first I've ever heard of EPO for malaria. Not saying it's not true, but it's new to me. -
The CEO of USADA Travis Tygart was the main lawyer involved in the BALCO scandal trial (and the following retirement of Regina Jacobs)...and finally got Lance Armstrong (under death threats!)...and now he is investigating Alberto Salazar.
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ventolin^3 wrote:
Malaria is no joke, it is worst illness imaginable
#1 target of the WHO ahead of TB -
that does it.
this cannot be a pro sport any more. -
Yup yup wrote:
I think Martin Lel said he had malaria before the 2008 Olympic marathon and said it was a miracle to finish 5th
That said, malaria is so prevalent in East Afroca that I am not sure that it is indicative of a doping cover up. Maybe but I would need to see more.
rjm33 wrote:
Oh my!
Here is a partial list of Kenyan runners who have had bouts of malaria:
1) Cosmos Ndeti
2) Moses Kiptanui
3) Paul Tergat
4) Dennis Kimetto
http://www.kenyarunners.com/pages/167372/index.htm
Keep reading the whole site page down!
...the Italian manager Dr. Gabriele Rosa (who was manager to Moses Tanui and Paul Tergat, and many other famous Kenyan runners both male and female) and EPO use rumors by top Kenyan runners is discussed a lot on this site!.....
rjm33...
I commend you on your research and trying to uncover a doping scandal.
That said, listing some sub-saharan African men that have had malaria really isn't even the beginning of proof of a doping scandal. It is unfortunately a widely prevalent disease and a big killer in Africa. You haven't shown that these men were given EPO and EPO is not a common medicine to be administered to malaria patients as the doctors in this thread have stated. In cases of severe anemia a blood transfusion would be preferred because it is instant.
Having malaria isn't performance enhancing.
A noble effort but really your chasing shadows here. -
TrackCoach wrote:
Europeans, more specifically the Scandinavian countries were blood doping by transfusing their own blood since the early 70s and using EPO since the late 70s. This is documented for endurance skiers, but I assume it wasn't long after that runners were using EPO as well. I am pretty sure, EPO predates the mid-80s.
rjm33 wrote:
In my opinion... no way on the EPO since late 70s claim you are making.
Do you have some evidence to back that statement. I do not think it had even been synthesized in a lab at that point.
The first clinical trial with recombinant EPO(Epogen) made by the biotech firm Amgen in the NEJM in Jan. 1987, and was approved for use in the US by the FDA in 1989...but as I showed in the NYT article...actual use goes back to 1986 or 1987...and I am going to try to find out if possibly a little earlier in Europe?
For another coincidence...Amgen...the biotech firm that sells Epogen...became a major sponsor of the Tour of California pro cycling race in the US!
.......you can't make this stuff up any better than actual history...
I arrived a little late to the party, but in terms of the history of synthetic and wide-spread availability of synthetic EPO, you can date it's discovery to 1983 .
“In 1983, the gene coding for EPO was identified, leading to its synthesis as epoetin-alfa by American genetic research corporation, Amgen, who patented the drug under the name Epogen. In 1989, another company, Ortho Biotech, a subsidiary of Johnson and Johnson, began marketing the drug under license as Procrit in the US, and Eprex in the rest of the world.â€
http://www.hematology.org/About/History/50-Years/1532.aspx
http://noblood.org/forum/content/179-erythropoietin_-28epo-29
TrackCoach is right in musing about Scandinavian countries experimenting with blood-doping as early as the 1970s, although it wasn't EPO.
Furthermore...
In terms of the connection between Malaria and EPO, treatment for severe cases (involving swelling of the brain and dangers related to cerebral symptoms) have shown EPO to be very effective.
http://jid.oxfordjournals.org/content/193/7/987.full (Oxford Journal)
While historically experiments involving EPO in treatment for severe cases of the malaria parasite have at least been linked since the early-to-mid 1990s and really gained steam in the early 2000s. I encourage you to look at the resources provided by the journal "Nature", linked below:
http://www.nature.com/icb/journal/v83/n6/full/icb200589a.html
Finally, my two cents. Scientifically, using EPO to treat severe symptoms of the parasite seems unlikely across the board for many Kenyan athletes, who train at a high level and would not only suffer from the effects of training, but having severe symptoms of the disease...
However, prescribing the drug as an "antidote" for "treatment" as a means of satisfying qualifications for athletes who may not feel they want to illegally gain an advantage and would otherwise find themselves put back by malaria (which is widespread), seems possible and maybe even likely. -
rjm33 wrote:
I have 1986 to 1987 as earliest EPO use...as you can see from this article on the DEATHS of 18 young Dutch and Belgian cyclists in the years 1987 to 1990...
http://www.nytimes.com/1991/05/19/us/stamina-building-drug-linked-to-athletes-deaths.html
Renato Canova has also already stated on the "EPO and mid distance thread" that Alberto Cova and Salvatore Antibo did do blood transfusions before they were banned in 1985 (even though there was no test for detection of transfusions).
Renato Canova has also stated that Salvatore Antibo stopped blood transfusions with the 1985 ban because he found that just doing altitude training was more effective than blood transfusions.
Renato Canova has also stated that Gelindo Bordin never did any blood transfusions, or EPO, and only used altitude training.
In 1986, Renato Canova became responsible for the Italian marathon team, along with his good friend Luciano Gigliotti, who was the coach of 1988 Olympic marathon gold medalist Gelindo Bordin and 2004 Olympic marathon gold medalist Sefano Baldini.
https://en.wikipedia.org/wiki/Renato_Canova
Yes, I have read most of the above. But this is about blood transfusions. Not the same as EPO. You haven't mentioned anything about Canova stating that EPO was being used as far back as 84, which you suggested previously. I don't know of any account or evidence of an international athlete (runner) using EPO in the 1980's.
Cheers. -
Medical resident here - no you'd never under any circumstances give EPO for malaria prophylaxis or treatment. Sickle cell trait provides natural immunity and patients with full blown sickle cell disease can be predisposed to anemia, however even in those cases of anemia, we give folic acid (not EPO) since this is commonly deficient in sickle cell patients due to rapid cell breakdown. The actual drugs you'd use for prophylaxis or treatment are Chloroquine, Mefloquine, etc.
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MD^10 wrote:
EPO can help a person with malaria but only when the RBC have dropped to extremely low levels.
Again, no you'd won't do this since the genesis of anemia is sickle cell patients is due to rapid cell cycling and breakdown. The anemia that develops is from a lack of folic acid since this is involved in cell division and genesis. For severely anemic patients with microcytic anemia (again, this wouldn't happen in sickle cell since lack of folic acid would yield a macro not microcytic anemia).
EPO is made naturally in the renal tubules of the kidney, so you'd give it to patients in kidney failure since the problem would be a lack of production. -
Turning to the LRC message boards for evidence is sad. Somebody get this guy a library card!
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ISBN wrote:
Yes, I have read most of the above. But this is about blood transfusions. Not the same as EPO. You haven't mentioned anything about Canova stating that EPO was being used as far back as 84, which you suggested previously. I don't know of any account or evidence of an international athlete (runner) using EPO in the 1980's.
Cheers.
Two historical notes here, the first:
"The sequence of the gene coding EPO was obtained for the first time by the United States firm Kirin Amgen (hereinafter referred to as Amgen), which took out patent US 4,703,008, applied for on 30 November 1984, and in which it described the amino acid sequence corresponding to human EPO.
...meaning they developed the gene code for synthetic EPO in 1983 (see previous post) and patented it in November 1984...
and also, it was suggested that Europe may have developed a sythetic EPO prior to the United States, but this seems unlikely:
"In Europe as in the United States, Genetics Institute has failed to obtain patent protection for EPO. The patent was based on exactly the same United States applications, numbers 677,813 of 4 December 1984, 688,622 of 3 January 1985 and 693,258 of 22 January 1985, which were never granted in the United States."
Source: http://apps.who.int/medicinedocs/en/d/Js4915e/2.9.html
Most importantly, the governance organizations monitoring athletics did not have a stable test to consistently overturn synthetic EPO use until the early 2000s, so it's unlikely any literature exists about use in the mid-1980s, although it's highly likely that EPO was being distributed and administered to athletes. One need only look at the "surprise" dominance of nations such as Spain, Morocco, and Italy at the World Cross Country Championships in the late-1980s and throughout the 1990s (in addition to other nations influenced by the exploitation from agencies in Europe) to see that doping was in effect.
Cheers! -
I have lived in Kenya for many years. From my experience, anyone who has a flu or a strong common cold, says it's malaria. Because that's what they tell them at the hospital. If I got a dollar for every time an athlete showed up in training saying: "Yeh, I had malaria 3 days ago, but now I'm okay" I would be rich. So when a top athlete says he had malaria 6 weeks ago and now he runs a world record, I assume he just had a cold.
Do you think any Kenyan athlete believes that you can get EPO as a treatment for malaria? No way! If doctors say it CAN be used, alright, but I have never heard that it's actually given as a malaria treatment in Kenya - not to athletes.
By the way, I know Erupe. I am very sure he is a doper. When he first ran 2.09 (in 2011) most Kenyans told me they were shocked - and so was I. He didn't seem talented at all. To be honest, I would have been surprised if he had run 2.14 -
Didn't Chris Froome claim to be treated for malaria before he won the TDF?
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As a physician who follows running just a few points that I would add:
- Malaria is highly prevalent in Kenya and as others have said there are 4 species and even for individual species the course varies dramatically depending on parasite burden (% of red blood cells infected). Many patients are able to be treated as outpatients with low % of involved RBCs but in severe cases malaria is a life threatening and even fatal disease even for young healthy patients. Some patient may have already been partially treated with prophylaxis as well which may make the illness more mild
- EPO is not commonly used in the management of malaria, as others have stated with malaria you can develop varying degrees of anemia requiring blood transfusion and can be anemic after treatment, but after the acute illness your body will produce EPO to allow you to recover your hemoglobin count without an expensive medication (EPO) that I wouldn't think is routinely available in Kenya anyways
- to conclude that everyone with a history of malaria has been treated with EPO is nonsense
- without knowing the severity of illness, no point to speculate about how long it would take a runner to recover to be able to race after reporting a bout of malaria
- just because a treatment isn't standard of care doesn't mean that you can't find a doctor to prescribe a treatment off-label. If that substance is also performance enhancing and isn't standard of care I would think that this would still constitute cheating for athletics, but doesn't mean that it wasn't prescribed by a physician or was illegal -
While an athlete claiming EPO use as therapy for malaria is unprecedented, here is a case where an athlete claimed malaria caused the suspicious fluctuations in her Biopassport.
Turkish athlete Alemitu Bekele was banned for 4 years on a biopassport violation. She gave suspicious three samples in competition between August 2009 and july 2010, then someone tipped off Turkish Athletics. She was put on the registered testing pool, and tested OOC in July, IC in August in Daegu, and OOC in November
Sample; HGB; RET
Sample 1: 15.1 0.67
Sample 2: 17.1 0.67
Sample 3: 17.1 0.17
Sample 4: 13.4 1.72
Sample 5: 14.1 1.65
Sample 6: 13.0 1.56
Ms Bekele was invited to provide an explanation for her abnormal profile, which she did through her national federation. Initially, on 23 February 2012 she put forward a somewhat skimpy "home made" response. On 1 March 2012, however, she withdrew that explanation and submitted a new, more considered response which in essence explained her elevated HGB by reference to a combination of factors including (1) the inhalation of pure oxygen under hyperbaric conditions; (2) training at altitude and in hot and humid conditions; and (3) various food supplements. This explanation was considered but rejected by the Expert Panel and she was then charged with a breach of Rule 32.2(b) by a letter dated 3 April 2012
She then appealed:
These were in summary as follows: (1) vaginal bleeding following the abortion of twins on 21 May 2009; (2) food poisoning and gastrointestinal infection from 2 to 11 September 2009; (3) lung pathology resulting from underwater training with pure oxygen from 8 March 2010 to 25 September 2010; (4) hyperthyroidism on 16 April 2010; and (5) severe malaria from 21 May 2011 to 10 November 2011.
Shotgun strategy of defense, with a ton of different excuses. Here is CAS's reaction to the malaria defense:
They confirmed that none of the potential explanations advanced by Ms Bekele (including her assertion that she had suffered two severe bouts of malaria in May and November 2011 respectively) accounted for the abnormal profile. The results in Samples 2 and 3 indicated a cessation of doping somewhere between one and three weeks before the respective events so as to avoid the danger of detection from a conventional doping test. They were 100% sure the tests did not show a false positive.
And just a final note
She had abandoned her appeal against the finding of the Penal Board because she did not have the finance to counter the expert evidence which the IAAF proposed to call at the hearing, in particular in regard to the question of malaria. In these circumstances, she had taken the difficult decision to pursue her appeal only against the four-year ban which had been imposed on her.
The CAS were pretty adamant about that defense though:
She had only abandoned her final defence that the readings in her ABP were due to malaria about a week before the hearing in the face of overwhelming scientific evidence that the defence was bogus. A four-year ban was fully justified.
http://www.doping.nl/media/kb/3017/CAS%202013_A_3080%20Alemitu%20Bekele-Degfa%20vs%20TAF%20%26%20IAAF%20(S).pdf
So, different from the OP about EPO treatment for Malaria. I wish there were more details on exactly how the IAAF witnesses Prof Schumacher and Prof D'Onofrio argued that Malaria was bogus. I want to know more about the possibility or impossibility of a ABP panel review seeing some abnormalities as a consequence of Malaria in isolation. -
I would not have suspected you got tested when you were sick with malaria, I think Lance was given a pass when he took PEDs for his cancer treatment.
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So far one person made an implausible EPO / malaria excuse.
I don't think it is productive to associate all references to malaria with doping. It can be a discussion when someone is using it as an excuse for EPO use. I have spent time in East Africa. Casual references to malaria can mean a lot of different things.
Kenya needs to address doping issues but chasing this malaria issue may undermine the overall worthy goal. -
From an endocrinologist (aka hormones doc)
Not typically, they can get an anemia I suppose that maybe you would give EPO for. -
I forget what name I use wrote:
I'm a scientist who often works in rural tropical areas. I've had malaria and it's not fun, but I never take drugs to prevent malaria. You just can't take it all the time. The local people don't take it. If you do one short-term trip to a malaria area, it's probably good to take something, but I'd be on it continuously and I don't want to do that.
I didn't read through the thread, but this is the first I've ever heard of EPO for malaria. Not saying it's not true, but it's new to me.
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