A very simple question

Dr EPO wrote:

You misunderstood my " lol " . I haven't exactly claimed that these are your theories , but theories that you obviously agree with. It was just funny, I think, that I was just waiting for Moen's development to be drawn into the debate so that I from my point of view could illuminate the same.Just a funny coincidence.

Maybe I did misunderstand your lol.

I'm on record as saying that Renato's ideas about EPO for top-athletes living and training at altitude would apply to non-Africans too, long before Moen's sub-2:06.

My thinking is more fundamental - if altitude "works" by naturally stimulating EPO production, then supplementing with more synthetic EPO becomes largely, if not completely superfluous.

This is supported by altitude studies finding similar gains in short term performance increases as EPO studies.

Renato adds an element of training that I can not, and I have no reasons to doubt.

extend the philosophy wrote:

Drug testing was introduced in 1965 for god reasons. Are you Disputing this?

The reason for so many products being banned now is that they are believed to be performance enhancing. The reasons given for that belief are not necessarily good science. Generally, most posters here actually believe that EPO allow the body to produce a higher maximal oxygen uptake, which is actually biologically impossible in a healthy person, regardless of training.

Maybe in cycling it was 1965 for "good" reasons.

Here is a similar timeline from the IAAF:

IAAF ANTI-DOPING FACT SHEET

IAAF historically a pioneering international sport federation:

1928 The IAAF becomes the First International Sport Federation to prohibit doping

1968 First international doping controls at Olympic Games

1969 First in-competition tests (ICT) conducted

Armstronglivs wrote:

rekrunner wrote:

I'm familiar -- it's just not relevant to determining effect.

And who was it who said he based his analysis on "real-world" conditions? Actual doping practices aren't sufficiently "real-world" for you? I guess you prefer your case studies in a laboratory rather than the Kenyan highlands. But not much racing going on there.

I also said "performance".

Some of these drug busts are out-of-competition, or whereabouts failures -- not linked to any specific performance.

Even then, the in-competition busts require a deeper, case by case analysis, to identify any potential confounders, and often lack a reliable clean reference. This is why "examples" have limited value.

I prefer studies that are carefully designed and controlled, to answer very narrow questions in the conditions that they are conducted, for a representative population.

Lacking relevant studies, I also prefer large data set analysis -- like you said before, observing the movement of the herd -- that can establish correlations. Correlations are still not causation, but at this point we lack correlation.

I do not prefer rumors, myth propagation, tabloid sensationalism, or faulty logic.

"Human studies committees are uncomfortable with the amount of hematocrit increase that the competitive athlete will risk, so we don't even know what the potential performance increase is with aggressive EPO use. It could increase performance by 10 percent."

And then,

"The lower amount of oxygen available at altitude stimulates your body to make additional red blood cells. This will not raise your hematocrit and blood volume like EPO and blood loading, but it can be helpful."

From that, I understand that the performance gains from EPO while difficult to measure are generally high and exceed those from altitude-training alone. I don't see from this kind of information why an altitude-trained athlete would not gain advantage from increased Hct obtained from additional synthetic EPO. Indeed, higher levels of Hct (in the high-50's) were sought by cyclists.

"My favorite quote about this entire subject comes from Jonathon Vaughters, an American who raced in Europe for three seasons."

"Vaughters said in 1997. 'When you use it like that, it's like turning a four-cylinder engine into an eight-cylinder engine.'"

What is the logic that suggests there is no connection between the fact an athlete has been caught doping and their performances? I assume that if you take a drug to remove a headache and the headache goes you see no causal relationship.

Armstronglivs wrote:

What is the logic that suggests there is no connection between the fact an athlete has been caught doping and their performances? I assume that if you take a drug to remove a headache and the headache goes you see no causal relationship.

There is a connection -- the doper believes performance will improve.

To determine if this belief is founded we need to measure performance, usually a time over distance.

To measure an improvement, we need two such measurements under identical conditions.

A bust does not give us any of these measurements.

I don't know what they mean by "performance". Are they even talking about running?

I'm also not swayed by "could increase" or "can be helpful" type of speculation.

For those who have studied superior performance of high altitude dwellers, 2000m-3000m seems to be a "sweet spot" for best performance. This suggests artificially loading beyond that will start to have detrimental effects.

I did find this part interesting:

What are the dangers of EPO and blood loading?

When you add more solid matter to a solution, it thickens. Blood has to circulate through some small blood vessels in the body. Capillaries are the smallest vessels, but there are some fairly small arteries that go to important parts of the body such as the heart and the brain.

There are numerous factors that can encourage the blood to clot within the body or that can act to impair circulation. The primary cause of death in most Western countries is blood clots — the ones that cause heart attacks and the ones that cause strokes.

When blood gets thick enough, it starts to circulate poorly and sludges or tends to thicken severely, especially in the smaller vessels. Your blood wouldn't be thick even if you boosted your hematocrit from 40 to 48 percent. However, if you boosted your hematocrit and then became dehydrated, you could be in trouble. Losing enough water from the blood to raise your hematocrit into the mid-50s can cause thickening to occur, and you can face a significant health risk.

A couple of points:

- Bans are not doled out for caffeine because 90% of world's population consumes caffeine on a daily basis more commonly in coffee, tea & soda pop beverages. Tylenol (acetaminophen) also enhances endurance performance (see Runner's World 07/25/2010), and it's not banned because it's a widely used OTC analgesic for all kinds of pain related problems. rHuEPO is a prescription drug that has a medical indication for anemia and needs to be used under a doctor's care. It's not widely used compared to the aforementioned and is a therapy for a subset of patients with anemia related to renal disease or cancer.

- If "EPO can shorten the time to get to 90% level of fitness," why would it only be beneficial in other events like race walking? Race walking very closely resembles marathon running in terms of aerobic energy requirement. It also requires a number of physiological attributes such as cardiovascular endurance, maximal oxygen uptake, lactate threshold, and technical and physiological efficiency or economy. Many male elite RWs have a VO2max in the 70's. Some were even former runners who transitioned to RW. If you're going to agree with the suggestion that EPO would be effective for RW then it would also be effective for distance runners, especially marathoners.

rekrunner wrote:

Armstronglivs wrote:

What is the logic that suggests there is no connection between the fact an athlete has been caught doping and their performances? I assume that if you take a drug to remove a headache and the headache goes you see no causal relationship.

There is a connection -- the doper believes performance will improve.

To determine if this belief is founded we need to measure performance, usually a time over distance.

To measure an improvement, we need two such measurements under identical conditions.

A bust does not give us any of these measurements.

Like a drug to fix a headache, an athlete dopes to achieve a desired outcome. It isn't an experiment. It has been done for decades. That we can't exactly measure the performance gains doesn't mean they aren't there. The safest assumption is that if an athlete dopes they will benefit performance-wise. That is why the practice is banned. Your argument would take us back to a point when doping had yet to be seriously employed and its effects largely unknown. You are a good century behind the times. I know a mask is now advocated for public health reasons but your blindfold seems rather unnecessary.

Informative article on blood doping, microdosing and the ABP:

https://www.cyclingnews.com/features/biological-passport-have-dopers-found-ways-to-beat-it/

The aim of micro-dosing is to illegally boost haemoglobin levels. The aim of altitude training is to legally boost haemoglobin levels. It's why there are concerns riders head to the latter and adopt the former.

"Anecdotal evidence suggests that dosages have decreased from 100 international units per kilogram of body mass a decade ago, to 5-10 units," explains Jakob Mørkeberg, senior science manager at Anti Doping Denmark. So around 5-10 per cent of the Armstrong era."

"But administration is performed more frequently now, such as five or six times a week instead of one large dose per week. That's a smaller performance increase but still two per cent. It also reduces the detection period, though that depends on the type of EPO used."

"Some experts believe that micro-dosing at 11pm leaves no anti-doping markers by six the next morning. Mørkeberg disputes this time frame but the fact a French lab recently made headlines for creating a test that detected micro-dosing for up to 48 hours instead of the current 24 hours, shows the difficulties WADA face."

"The French test requires further validation. Meanwhile, numerous studies question the credibility of the ABP. Take 2011 research by anti-doping expert Michael Ashenden that saw him inject healthy volunteers twice weekly with EPO for up to 12 weeks."

"The treatment resulted in a 10 per cent increase in haemoglobin mass, the equivalent of two bags of reinfused blood."

"But the ABP did not flag any suspicions of doping," said the study."

What is the bottom line on EPO and blood loading from the perspective of a sports medicine and emergency medicine physician?

"This is an effective performance-enhancing method that may have effectiveness over a wide range of distances and durations — in running from a quarter-mile to an ultramarathon. It is also effective in many other sports."

I believe that EPO will go the way of Caffeine and not be banned by 2040 or thereabouts. It's performing enhancing qualities will be equivalent to an altitude tent and acceptable like Advil or caffeine.

Sapel wrote:

I believe that EPO will go the way of Caffeine and not be banned by 2040 or thereabouts. It's performing enhancing qualities will be equivalent to an altitude tent and acceptable like Advil or caffeine.

Except there are health risks.

WADA President Witold Bańka said: “Throughout the COVID-19 pandemic, WADA has been keeping in close contact with Anti-Doping Organizations in order to provide leadership and support in the face of this unprecedented situation. As always, our first priority must be public health, safety and social responsibility. Therefore, we continue to urge everyone to follow closely the advice of relevant health authorities and government agencies.

“Where testing programs can resume, we are providing clear guidance so that the integrity of the system can be maintained without jeopardizing the health of athletes, sample collection personnel or anyone coming into contact with them. It is crucial that the system can return to full power as quickly as possible once the various restrictions are lifted, in line with the different circumstances around the world.

Professore il simplice fatto che queste performance sono state fatte in questo periodo e non in gare sanzionate crea piu' domande che risposte.

One of the biggest misunderstandigs is to connect the level of Hb and Hct with the level of performances. I have no doubt that, taking EPO, everybody, including athletes training in altitude, can raise their Hct and their Hb to very high values (till the absurdity of 60 and more than 20 found in Abraham Kiptum). However, I don't think this is a very important factor, if considered alone.

Several times I pointed out that Gelindo Bordin won Olympics in Seoul with 39.7 of Hct.

Christopher Koskei, the first Kenyan I coached who won WCh in 1999, one week before the final in Seville and 3 days after the World Military Championships in Zagreb had Hct under 40.

At the same time, Gennaro Di Napoli had natural Hct between 51 and 53, and his Hb was near 19 (when had 17.5 he was in anemia).

The generalization of these values, considered not as EFFECTS of training combined with genetic baggage, is something that never I can accept. This means that creating a "limit" valid for everybody, and deciding that a level of 50, for example, can be dangerous for the health or can give unfair advantage, is a very stupid action, because several athletes in the specialism of endurance (running, biking, skiing) have natural values higher than that, but also some of them has very low natural values. In the last case, if the theory that enhancing Hct can produce effects on the performance, athletes with "natural" 40 could artificially enhance the level till 50, while athletes already with 50 couldn't do anything.

There is not only the ability to transport Oxygen at the base of a performance : everybody, athletes included, have to respect a optimal balance among all the physiological systems, and we try to manipulate one of them, at the same time we go to create problems to the others.

I use to have normal blood tests with the athletes of my group (of course, not testing a lot of parameters as I did in the period between 1992 and 2003, when I worked together with the responsible of hematology of Turin University, because there was, at that time, a good budget for researches, and to test training of Italian runners and Kenyan, from altitude (Sestriere) and sea level, was something interesting for the researchers of the University), for controlling some basic value : Hb, Hct, MCV, RBC, WBC, PLT, Iron, Ferritin, Vitamins, and NEVER found some direct relation between the level of Hb and Hct and performance.

Athletes like Arne Gabius (13'13" and 2:08), who is doctor, had the level of Hct absolutely uniform (always in the range 41-42), when was in top shape, and when was out of shape.

These are real data, not something from lab tests (maybe on treadmill or with amateurs), and are the reason because I built step by step my convinctions about EPO and blood parameters, that are always confuted by people without any real practical experience on the ground.

Armstronglivs wrote:

Like a drug to fix a headache, an athlete dopes to achieve a desired outcome. It isn't an experiment. It has been done for decades. That we can't exactly measure the performance gains doesn't mean they aren't there. The safest assumption is that if an athlete dopes they will benefit performance-wise. That is why the practice is banned. Your argument would take us back to a point when doping had yet to be seriously employed and its effects largely unknown. You are a good century behind the times. I know a mask is now advocated for public health reasons but your blindfold seems rather unnecessary.

Yes -- athletes dope, desiring to achieve an outcome, and it is an assumption that they will benefit performance-wise.

One century ago is still within the Age of Enlightment. We'd have to go further back to the Dark Ages that were characterized by a lack of scientific rigor. For that matter, in this century we also seem to be regressing back to these earlier times where scientific principles are replaced by popular vote or authoritarian decree.

This only serves to underscore how nonsensical it is to use the term "performance-enhancing drugs" when many performance enhancing drugs are not banned, and many drugs are banned based on a committee determination of being potentially performance enhancing. Even worse nonsense is the self-cancelling phrase "performance-enhancing drugs don’t actually enhance performance".

Besides sharing the common trait of requiring aerobic energy, race-walking and cycling have different physiological characteristics, demands, and limiting factors. Yet you may be on the right path to also to doubt the beneficial effect of EPO for the highly trained cyclists and walkers too. I do recall reading two meta-studies concluding an over-estimated effect in the best EPO studies on cycling -- one analyzing physiologically, and the other mathematically.

Although data by event is rare, one analysis strongly suggesting against EPO benefit for marathoners is the Sunday Times analysis of Olympic and World Championship medals won by "suspicious" athletes, finding 1 in 9 (11%) medals suspicious. Alternatively 8 in 9 medals were won by athletes never having suspicious blood values. Compare this to race-walking where the medals won statistics were 52% and 48%. 11% is even below the overall average of "suspicious" athletes at 14% (Alternatively, 6 in 7 athletes were not ever "suspicious").

But then the anti doping has a very good fair instrument( also the whereabouts )in the biological passport to just find abnormal fluctuations in the individual runner that with 99.999 % determines doping.

Dr EPO wrote:

Renato Canova wrote:

One of the biggest misunderstandigs is to connect the level of Hb and Hct with the level of performances.

...

But then the anti doping has a very good fair instrument( also the whereabouts )in the biological passport to just find abnormal fluctuations in the individual runner that with 99.999 % determines doping.

Abnormal fluctuations have not been connected to the level of performance either.

This is slightly off-topic, but another common misunderstanding is thinking there is a clear direct mathematical relation between a false positive and a true positive. It is common, but wrong, to think that a 0.1% chance of a false positive suggests a 99.9% chance that it is a true positive.

Maybe the best way to understand this is to realize that the distribution curve of negative values and positive values are not the same. The distribution of positive values would be shifted to the right on a graph. (Let's assume the simple case for illustration, and not something complex like RET% where extreme values can be to the far left or to the far right.)

Choosing a 99.9% threshold on the negative curve:

- Indicates 99.9% of the distribution to the left of the threshold (true negatives)

- Indicates 0.1% of the distribution to the right of the threshold (false positives)

- But, depending on the distributions of positive values, a 99.9% threshold on the negative curve may coincide with a 50% threshold on the positive curve -- indicating a 50% chance of a true positive rather than 99.9%.

Analyzing these two curves also clearly illustrate another common complaint of the ABP, that "thresholds are too generous". In my hypothetical example above, the price of minimizing false positives is that 50% of false negatives go undetected. This is the trade-off when the goal is to "protect clean athletes". We want to protect them from competing against dopers, but we also want to protect them against false prosecution. This is partly, but not completely, mitigated by using sliding individual thresholds, by using a lower threshold to flag abnormal curves than is used to prosecute abnormal curves, and more frequent testing or targeted testing among the fastest athletes.

While we do have reference population distributions for negatives for different populations (at sea-level and at altitude), the true distribution curve for positives would be difficult to generate as dosages can vary, and the timing from the last intervention is also relevant.

The reality is further muddied by several non-doping sources that can alter blood values: altitude, illness, hemoconcentration/hypovolemia, from strenuous exercise or dehydration, recent blood loss, medication, etc. (ignoring process errors if rigorous standards are not applied). This increased variability from known non-doping factors shows why it is so important for a panel of experts aware of all these pitfalls to subjectively analyze any curves automatically flagged by the software (using a lower threshold to minimize false negatives), with a detailed data package that also describes the context of recent significant events (recent stays at altitude, illness, etc.)