EPO deaths made for good news stories, even if there was no autopsy evidence that EPO was actually killing cyclists. However, the New York Times knew the connection between EPO and the apparent boomlet in dead cyclists was speculative, and admitted so a week later. Backtracking, the Times ran a correction: “A picture caption last Sunday with an article about a stamina-building drug linked to athletes’ deaths misstated what is known about the death of the Dutch cyclist Johannes Draaijer. An autopsy did not specify the cause, and it is not known conclusively whether he had used the drug.” Despite the correction, the rumor was already set: EPO was a new drug of athlete destruction.
If you take a lot of EPO without a doctor’s supervision, in theory you can kill yourself. As University of Oklahoma chief of hematology Dr. Randy Eichner explained in the Times piece, increasing red-blood-cell count can thicken blood. Take too much EPO and “pretty soon you have mud instead of blood; then you have trouble.” The results can be blood clotting, stroke, or heart failure. The Times also cited Ed Burke, the USCF physiologist who oversaw the 1984 Olympic cycling team’s blood boosting. “EPO can do wonders for your aerobic capacity,” Burke noted, before warning, “The problem is, it can also kill you.”
By sensationalizing the potentially deadly effects of EPO without reporting any evidence for a correlation with actual events, the New York Times seemed to be taking up the role of an anti-doping missionary whose conclusions are based on faith rather than evidence. Under a hematologist’s expert care, EPO is safe. The drug saves thousands of lives every year. Yet because this drama-killing statement of fact contradicted the sensationalist thrust of a story about a scary new athlete killer, that is not the story that snowballed in the press.
In a New England Journal of Medicine (NEJM) article on the therapeutic uses of EPO published on May 9, 1991, 10 days before the Times piece, hematologist Dr. Allan Erslev wrote that erythropoietin “appears to be almost nontoxic.” Born in Denmark, Erslev graduated from medical school in 1945 and then traveled to the United States to conduct postgraduate research at Yale and at New York’s Sloan Kettering Institute. Testing anemic rabbits in the early 1950s, Erslev was one of the first to identify the blood-regulating effect of EPO. In his 1991 NEJM piece, Erslev theorized that since EPO seemed to be nontoxic, it was viable for elective surgery patients who were concerned about contracting AIDS from donated blood. At a time when the blood-borne autoimmune-deficiency disease dominated headlines, surgery patents were afraid to use anonymously donated blood from blood banks. To eliminate the perceived risk, patients stored their own blood in advance of surgery. However, this blood banking created the problem of already sick or injured patients making themselves anemic in advance of surgery. Using America’s most esteemed medical journal to broadcast his message, Erslev told the surgical community that by using EPO, patients could safely extract and store more blood than was otherwise recommended without suffering a lower hematocrit level. With EPO therapies, “the number of donations could undoubtedly be increased,” he advised.
Erslev also wondered whether EPO could have a role as a rehabilitative therapy for endurance athletes. In 1991—the midst of the popular press’s EPO-kills-cyclists panic—Erslev asked if “athletes engaged in exhausting long-distance events such as swimming, running, bicycle racing, or cross-country skiing would benefit from a moderate rise in hematocrit and red-cell mass.” Since many world-class athletes were already anemic because their training regimes increased plasma volume and thereby diluted red-cell density, Erslev seemed to posit that the use of EPO as a sports medicine recovery therapy would merit further investigation.15
As for EPO dangers, Erslev postulated that the combination of lower blood volume from dehydration and higher hematocrit from EPO “would increase blood viscosity and be not only detrimental to muscular action but also the cause of possible life-threatening thrombosis.” In other words, an athlete would be both slower and more likely to die from a blood clot in the brain. While Erslev did not have studies to prove it, in theory, it would seem that EPO would both decrease muscle performance and potentially thicken blood to the point that it might kill you. In spite of these theoretical complications, Erslev reported that the studies he had run indicated that the blood-clot problem was “quite sporadic” and in some clinical tests “nonexistent.”
Ten days after the publication of Erslev’s article, news sources were calling the sports world to EPO panic stations. On July 14, 1991, Britain’s Independent ran a piece with a stretched-out title worthy of its endurance topic: “Cyclists Don’t Die Like This; Cycle Racing Gets Tough—and Sometimes Racers Die: But on the Track, Not at Home, in Bed, in Their Prime. Not 18 of Them. So Were They Abusing a Billion-Dollar Wonder Drug?” The piece began with a vignette of Draaijer’s wife, Lisa, waking up to a gurgling sound—her husband’s death rattle. It then listed other cyclists who had passed away, including Dutch pro Ruud Brouwers who fell out of bed and died on May 3, 1989, and Dutch amateur Connie Meijer, dead after abandoning a criterium on August 17, 1988. Heart failure had killed 18 cyclists in all, the Independent claimed.
The Independent writer rang up retired 1970s Dutch pro Henk Vogels at his home in Australia. Vogels told the journalist, “Half the people I cycled with are now dead. They often die in their early forties after 15 years of taking stuff and going all out.” In the same piece, 1984 U.S. Olympic cycling team doctor Ed Burke warned UK readers that EPO abuse “raises the red-cell count to the point where it turns the blood into sludge.”
A decade later, Burke died of a sudden heart attack while cycling near his Colorado Springs home, a victim of sudden cardiac failure, the number-one killer of athletes. Burke was 53. While no one blamed his death on dope, in the early 1990s, both Burke and the journalists who quoted him were quick to pin the cardiac failure of 18 cyclists on EPO. These pieces came at such a fast pace that a supposition became received wisdom: EPO is a mass killer.