Scientists & doctors please chime in - Is EPO a prescription given to malaria patients as a 2:05 marathoner claims?

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.

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.

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 .

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.

(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:

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.

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.

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!

Two historical notes here, the first:

...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:

Source:

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?

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 NovemberSample; HGB; RETSample 1: 15.1 0.67Sample 2: 17.1 0.67Sample 3: 17.1 0.17Sample 4: 13.4 1.72Sample 5: 14.1 1.65Sample 6: 13.0 1.56

She then appealed:

Shotgun strategy of defense, with a ton of different excuses. Here is CAS's reaction to the malaria defense:

And just a final note

The CAS were pretty adamant about that defense though:

(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.

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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