When López performed the same analysis of coverage in the popular press, he found an even bigger mess of chronology and nationality. News reports put the number of EPO “victims” anywhere from 7 to 40, from countries including Spain, Holland, Belgium, Germany, and Poland as well as generic “Europe.” Moreover, the articles cited athletes dying from EPO beginning in 1970, even though EPO was not produced for clinical trials until 1986.
When López broadened the scope of his search to include newspapers, magazines, blogs, and cycling websites for mentions of sudden deaths among cyclists between 1987 and early 2010, he found 49 cyclist sudden-death stories. In the time frame most often mentioned as ground zero for EPO deaths, 1987 to 1992, López unearthed news reports of 17 sudden deaths in Belgium, Holland, France, and the UK. These numbers are in line with the expected number of deaths from naturally occurring heart failures in athletes and the general population.
According to López’s research from 1995 to 2006, 180 athlete sudden deaths were reported in Spain alone—about 15 per year. Of that total, 39 deaths were cyclists and 40 were soccer players. In other words, whether the number of cyclist deaths in Europe in the early 1990s was 15, 17, 18, or 20, those numbers do not reflect a spike, but rather a death rate entirely consistent with normal athlete sudden-death statistics in a single European country and low for all of Europe combined.
Compared to sudden cardiac deaths in both the athletic and larger population, the “explosion” of cyclist deaths that supposedly came at the hand of EPO does not seem like an anomaly; that number of deaths is normal. The anomaly was the arrival of a new, highly effective doping product. Blinded by a rising anti-doping fervor, journalists and medical researchers alike seemed to have superimposed EPO onto normal death rates and created a crisis where there was little, if any, postmortem evidence to suggest a correlation between EPO and fatalities. Yet the ghosts of the mythical 18 cyclists still haunt us today. As recently as 2012, an academic review of scientific studies on the effectiveness and safety of erythropoietin mentions the possible link between EPO and “18 European professional cyclists [who] have died.”
The narrative about crime, death, and drugs was believable because—three years after the 1988 approval of EPO use in Europe—the story sounded logical. Athletes eager to win plus a potentially dangerous new drug equaled death. When I called López at his home south of Barcelona, he told me he has yet to find a scrap of hard evidence linking EPO with any cyclist’s death in the early 1990s. With the weary sigh of a man who had discovered a truth no one wanted to hear, he told me, “Science has not produced so far—at least to my knowledge—any conclusive evidence linking EPO with sudden death.” While dozens of papers continue to speculate about a link between EPO and the rash of Belgian and Dutch deaths, “they are just reproducing the myth,” López explained.
As López sees it, the role of the EPO deaths in the war on drugs in sport is analogous to the role fictional weapons of mass destruction played in the justification of the United States’ invasion of Iraq in 2003. “There was a war to be waged, and the people waging that war needed justification, an excuse, a solid reason,” he observed. Turning back to the EPO fiction, he said, “The best reason for waging that war is that doping kills. ‘We honest men, we must stop athletes from taking drugs because we are interested in saving their lives.’” By exaggerating and distorting the EPO story, the anti-doping establishment was able to predict a dire future. And a bleak tomorrow creates incentives for stronger, better-funded anti-doping measures while also spinning far more compelling media narratives.
In 1906, Olympic founder Pierre de Coubertin described the Olympic Games as a “program of moral purification.”26 This mission carries on today as an anti-doping errand in a chemically polluted sporting wilderness. For López, there is a link between the foundation of Olympic sports as a morally purifying, soul-cleansing experience and Olympic sports’ ongoing efforts to preserve what the WADA code formally labels the “spirit of sport.” “Well, actually,” López clarified for me, “they are interested in saving their souls, but they pretended that they were interested in saving their lives.”
My own search of medical literature finds plenty of warnings about the dangers of too much EPO. And there are many examples of pharmaceutical companies paying physicians kickbacks to overdose patients, a process that inadvertently accelerates the growth of deadly tumors. However, I found no documented instances of EPO killing already healthy humans, athletes or otherwise.
In December 2006, Danish researchers reported that 10 percent of a clinical trial group of 516 head and neck cancer patients on heavy EPO doses experienced accelerating tumor growth, even while undergoing radiation treatment.27 This confirmed studies going back to 2003, which also showed that EPO could boost cancer growth. And 10 years earlier, a 1996 study of dialysis patients was halted because patients on high EPO dosages suffered more heart attacks than a control group on lower amounts of EPO.
The deaths were not related to something that was inherently destructive about EPO. Instead, they were caused by overdosing. In 2007, Johnson & Johnson’s annual EPO sales were $3.5 billion, while Amgen moved $5.6 billion worth of the product. To attain these astronomical numbers, Amgen and Johnson & Johnson built incentive programs that financially rewarded doctors who administered heavy “off-label” doses of EPO to cancer and anemia patients. One West Coast office of six oncologists pocketed $2.7 million in incentives from Amgen in 2006 alone. The nationwide priming of the EPO pump led to a well-documented rash of heart attacks and carcinoma deaths in cancer and renal failure patients—so many that in 2007, the FDA released a report suggesting the dollar-incentivized high doses were neither improving nor extending patient lives.