EPO 'doesn't work,' scientists claim (Lancet study)

Massively flawed study. Reads more like a made-to-order propaganda piece.

science fiction wrote:

Massively flawed study. Reads more like a made-to-order propaganda piece.

Please elaborate on the flaws. First, have you read the entire study or just the articles in the Telegraph?

Where did they find EPO-free cyclists for the control group?

I haven't read the full study yet, but the way they present the statistics in the summary is odd. It's performance of the test group vs performance of the placebo group rather than improvement over baseline for either group which is the normal way of doing such things. If this is so then uncertainty in the result isn't well constrained and one can't really dismiss the possibility that the study is designed to produce a null result.

Further, even if the result were reliable, an improvement in maximal power output is a tactical advantage in cycling. I'm skeptical about the "no affect on sub maximal performance" result because virtually everyone else who's done related studies have found improvement in sub-max performance.

I have read both. The conclusions of the study are bad enough, but the Telegraph article is even more misleading than the study, because it quotes some of the study researchers who are clearly biased.

The study itself has a number of problems. The methodology they used looks relatively unbiased, but the conclusions are pretty fantastical. The gains in maximal performance are cavalierly dismissed as not applicable in a real race. The submaximal performance test appears to be quite convoluted and subjective.

The study used the performance of the group in a single "race" up Mt. Ventoux as conclusive evidence of the ineffectiveness of rEPO. The results of this one race may have seemed like a “gotcha” moment for the researchers, but when you are going up against decades of real-world race data that indicate just the opposite, your one test loses most of its significance.

Based on this one small study, the researchers somehow feel justified to state an incredibly overreaching conclusion that goes against not only decades of true racing experience, but also conflicts with the majority of credible rEPO research done to date:

Additionally, the researchers’ anti-rEPO bias is clearly seen when they quote previous research done on the clinical safety of rEPO:

This statement is highly misleading and not at all applicable to this situation. All research on the safety of rEPO has been done on people with serious underlying health issues, such as kidney failure, HIV and cancer. It makes sense that these people do benefit from having thinner blood, but these effects are not applicable for healthy people. I am not aware of any research that has been done to date on the safety of rEPO on healthy people. Neither Amgen nor Janssen have done research in this area because healthy athletes are not officially their target market. Only sick people are (officially).

And that just represents some of the flawed elements of this study. There is a lot more scientific garbage in the Telegraph article that needs to be seriously challenged.

science fiction wrote:

Additionally, the researchers’ anti-rEPO bias is clearly seen when they quote previous research done on the clinical safety of rEPO:

They have an earlier paper surveying the literature. They basically say previous work is flawed. That paper is written in a very pr-savvy, journo friendly, style.

NYCMaster wrote:

Well-trained cyclists were tested in both the laboratory and in a mountain-climbing race after some were given 8 weeks of regular EPO injections and the rest received only a placebo.

http://www.thelancet.com/journals/lanhae/article/PIIS2352-3026

(17)30105-9/fulltext?elsca1=tlpr

It turns out that the cyclists given EPO showed roughly 3% better maximal power output and 5% better VO2-max, BUT submaximal performance was not affected.

Nevertheless, the headline conclusion that the scientists reached is that EPO may be not be effective in aiding racing performance.

http://www.telegraph.co.uk/science/2017/06/29/lance-armstrongs-drug-choice-epo-doesnt-work-scientists-claim/

I'm starting to get really annoyed at the number of people taking this study and the supposed implication that "EPO Doesn't Work" seriously.

First of all, the Tour de France is a 3 week event. EPO isn't taken for single day events, like the single Mt. Ventoux trial used in the study. EPO is taken for multi-day events because can dramatically improve the ability to recover.

Second, if you take EPO you don't do the same workouts you would have done without EPO! You do more workouts and harder ones because the EPO lets you recover faster! That is not the case in this study - I would assume, please correct me if I'm wrong - that the control group does the same workouts as the doping group. You get faster from workouts, and doping without doing more/harder workouts won't get you results!

Third, they administer EPO once weekly for 8 weeks. The half life of a red blood cell is 120 days, so roughly 17 weeks. I'd be much more convinced if they had done a longer study. As we know, 8 weeks isn't much time to make tremendous gains in training.

Fourth, how can you say "EPO doesn't work" when you give it to some average Joes and insist that the effects apply to Pro Tour cyclists who have been training 4+ hrs a day for at least a decade? The physiological limitations in these two groups are likely to be completely different.

Science by Press Release wrote:

science fiction wrote:

Additionally, the researchers’ anti-rEPO bias is clearly seen when they quote previous research done on the clinical safety of rEPO:

They have an earlier paper surveying the literature. They basically say previous work is flawed. That paper is written in a very pr-savvy, journo friendly, style.

All the sensational claims these people make just scream "We've been hired to show that rEPO is ineffective in athletes because we hope that if we keep saying it, we will convince athletes to stay away from it." While this may be a noble goal, I doubt it will have an effect.

But let's see what WADA does. If they take rEPO off the PED list, I am willing to consider taking this type of "research" seriously.

science fiction wrote:

But let's see what WADA does. If they take rEPO off the PED list, I am willing to consider taking this type of "research" seriously.

I'm with your earlier post: If WADA decides anything "based on this one small study," I will conclude that they are stupider, lazier or more corrupt than I thought.

science fiction wrote:

Based on this one small study, the researchers somehow feel justified to state an incredibly overreaching conclusion that goes against not only decades of true racing experience, but also conflicts with the majority of credible rEPO research done to date....

Yes, this wreaks of "science by press release," where the actual research does not justify the conclusions drawn from it. In this case, it does seem that other research is held to a higher standard than their own work. They may very well be right about the flaws in existing studies, but that says nothing about whether their study is well put together.

I agree with Citizen Runner -- these guys used a very strange design. At least from the summary, it appears they simply compare means of various tests between doped and undoped after treatment. It's hard to understand why they didn't also compare individual and group performance before and after treatment. Such comparisons would give us a crude way to control for other differences among athletes, such as training methods, diet, existing fitness, etc.. Who knows, maybe some training regimens respond better to EPO than others.

I'm enough of a Bayesian to also agree with SF that one flawed study is not grounds enough to justify ignoring a ton of other flawed studies, and the evidence from the real world. My prior based on that evidence, imperfect as it is, is too strong to be swayed by one study.

For me, the real take away is how little we know for sure about these issues, and how hard it is to carry out good research on people.

Science by Press Release wrote:

Yes, this wreaks of "science by press release,"

Ooops! Make that, "REEKS" of "science by press release,"...

Citizen Runner wrote:

I haven't read the full study yet, but the way they present the statistics in the summary is odd. It's performance of the test group vs performance of the placebo group rather than improvement over baseline for either group which is the normal way of doing such things.

In all fairness, I am pretty sure they did do a baseline study before the test began and compared the eventual lab results to that baseline.

But not for the Ventoux race results, which they present as the ultimate proof of their concept.

"They did a great job," said Dr. Don Catlin, a retired UCLA professor and pioneer of anti-doping tests in sports. "Their paper will stand as a model for future research studies."

So you can stop arguing about why the study, in your opinion, was flawed.

The real question is why would the study participants clearly show increased performance in shorter, high intensity lab work, but not in an all out race up a mountain, a la Lance Armstrong?

Can anyone point to other studies that have tested the benefits of EPO on events with duration of more than 1 hour?

science fiction wrote:

In all fairness, I am pretty sure they did do a baseline study before the test began and compared the eventual lab results to that baseline.

I looked again. I think we are both right and wrong. As you say, they are doing a baseline, and tests every few weeks. If I read Table 2 correctly, they aren't doing direct comparisons of the beginning and ending. Instead, they take the performance means at the beginning and then every two weeks starting at day 11. They then take the mean of those means, and compare those.

Perhaps a bigger problem has to do with workouts. They told their subjects "to maintain their usual training programme throughout the study." So their are no controls for different regimens. Moreover, their measurements show that the two groups differed by quite a bit in how often, and hard they worked out. For instance, the EPO group worked out an hour less/week (4.9 v. 5.9). They say the difference is statistically insignificant. This is exactly the sort of blind evocation of statistical significance that drives statisticians nuts. Is there anyone who thinks that working out 20% is substantively insignificant.

I have to run, but will say more later.

jamesdole wrote:

"They did a great job," said Dr. Don Catlin, a retired UCLA professor and pioneer of anti-doping tests in sports. "Their paper will stand as a model for future research studies."

So you can stop arguing about why the study, in your opinion, was flawed.

Based on the above quote, I have sent a request to WADA to have EPO removed from the PED list. I expect Dr. Catlin's opinion will weigh heavily on their ultimate decision.

Can anyone point to other studies that have tested the benefits of EPO on events with duration of more than 1 hour?

You mean other than the results of the last 27 years of the Tour de France?

Not quite the "gotcha" moment you were looking for, eh luv2run?

EPO can't possibly work. Armstrong barely broke 3 in the marathon.

obvious massive psy-op from probably iaaf/nike themselves .

obviously listen to the rubbish get on boards here and from the

likes of apologists like conova

who is nothing but glorified drug pusher and absolute liar and deceiver

doesnt work , oh why is it banned again

pure analysis of times showes otherwise

well doesnt work but nike will still sent millions each year to kenyan athletics

to but the stuff for their athletes

nike always okay as have their undetectable epo nike sauce

NYCMaster wrote:

It turns out that the cyclists given EPO showed roughly 3% better maximal power output and 5% better VO2-max, BUT submaximal performance was not affected.

This is exactly why it's most beneficial to cyclists in the Tour. Elevated hemoglobin levels are most effective at maximum aerobic effort like when attempting a breakaway during a mountain stage. Once the break has been established, the riders settle into a steady state in which the extra capacity is of little to no benefit. The data shows how doping with EPO works, then the authors whitewash their own findings. Strange.