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I am dubious, will try to get my doctor neighbour to look for those author's names later.

There is a lot of evidence to support the theory that epo is very effective.
 

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I am dubious, will try to get my doctor neighbour to look for those author's names later.

There is a lot of evidence to support the theory that epo is very effective.
I think the whole point of the study is that there is in fact zero such evidence to support that theory.

This is the first time such detailed research has been done because it is expensive. “We are a foundation and we have financed it ourselves simply because we want to know. It has cost us about €500,000,” says Cohen.
 

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I usually don't read science stories from non-science publications, and this is a good example of why. The study hasn't been published, it hasn't been peer reviewed, it hasn't been replicated, and yet the articles state conclusions like:

New findings cast doubt on the performance enhancement offered by EPO


when that isn't likely a possible conclusion from the study itself. What it can conclude is more a along the lines of

New findings cast doubt on the performance enhancement offered by an 8 week course of EPO, with all other factors staying the same, on a single day 130km climb.

But I don't think anyone involved in top tier athletics doesn't doubt that already. Regardless there are likely some doping doctors with robust studies who can show exactly where EPO fits into a training regimen.
 

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I usually don't read science stories from non-science publications, and this is a good example of why. The study hasn't been published, it hasn't been peer reviewed, it hasn't been replicated, and yet the articles state conclusions like:

New findings cast doubt on the performance enhancement offered by EPO


when that isn't likely a possible conclusion from the study itself. What it can conclude is more a along the lines of

New findings cast doubt on the performance enhancement offered by an 8 week course of EPO, with all other factors staying the same, on a single day 130km climb.

But I don't think anyone involved in top tier athletics doesn't doubt that already. Regardless there are likely some doping doctors with robust studies who can show exactly where EPO fits into a training regimen.
Few studies ever get replicated, especially one like this, so that's a bit of a red herring (many classics in psychology didn't get replicated for decades, which is one cause for the replication failure in that discipline...). But the larger point is that applied sport cases will only provide anecdotal evidence. People like Ferrari don't use controls etc. As a neuroscientist, I wouldn't be surprised at all that part of the effectiveness of EPO derives from an expectation effect, which we know has considerable influence on outcomes in psychiatry, for example (to this day, it's still unclear whether SSRI's do anything for mild depression despite their popularity). The placebo effect is so robust that many pre-clinical steps can easily manipulate outcomes by weeding out people for whom there's no placebo effect. Given the role of central fatigue, expectation could play some role in performance especially if the athlete strongly believes in the efficacy of the drug they're given.
 

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There is so much missing information in this article, I wouldn't trust anything it says. If you believe that the study authors are scientifically ethical, then the study could have merit, but missing information raises more questions than it provides answers. Here are just a few:

1. What was the difference in red blood cells, hemoglobin, hematocrit between the two groups?

2. If there is statistically significant difference in hematology, is it clinically significant?

3. What was their safety protocol for those receiving epoetin? What measures were taken when the hemoglobin/hematocrit became too high? How many in the study had this happen?

From the article: Every week each rider attended the lab to complete endurance tests, including VO2max, and to give blood samples. These were locked away so nobody could use them to identify who had the EPO in their veins until the whole experiment was over.

This would never occur in a true scientific human study (too dangerous). Somebody knew the results, just not sure who.

4. There is no way that researchers could be totally blinded (for safety reasons). The blinding protocol is important in this study.

5. Were power/weight ratios the same for all participants? Climbing could be significantly different just based on the athletes attributes. Did they control for training leading up to the final climb?

Too many unknown variables to make any conclusion at this time.
 

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There is so much missing information in this article, I wouldn't trust anything it says. If you believe that the study authors are scientifically ethical, then the study could have merit, but missing information raises more questions than it provides answers. Here are just a few:

1. What was the difference in red blood cells, hemoglobin, hematocrit between the two groups?

2. If there is statistically significant difference in hematology, is it clinically significant?

3. What was their safety protocol for those receiving epoetin? What measures were taken when the hemoglobin/hematocrit became too high? How many in the study had this happen?

From the article: Every week each rider attended the lab to complete endurance tests, including VO2max, and to give blood samples. These were locked away so nobody could use them to identify who had the EPO in their veins until the whole experiment was over.

This would never occur in a true scientific human study (too dangerous). Somebody knew the results, just not sure who.

4. There is no way that researchers could be totally blinded (for safety reasons). The blinding protocol is important in this study.

5. Were power/weight ratios the same for all participants? Climbing could be significantly different just based on the athletes attributes. Did they control for training leading up to the final climb?

Too many unknown variables to make any conclusion at this time.
as the article says, the research group is writing up the results for peer-reviewed publication. They can't release the details you mention since putting them in the news article would constitute prior publication (which would disqualify the peer-reviewed article, as it's a condition of publication that the results have not been previously published).

As for your double-blind comments, those aren't correct. This is a standard protocol used in clinical drug trials (for many drugs that have far more potential health complications than EPO).
 

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as the article says, the research group is writing up the results for peer-reviewed publication. They can't release the details you mention since putting them in the news article would constitute prior publication (which would disqualify the peer-reviewed article, as it's a condition of publication that the results have not been previously published).

As for your double-blind comments, those aren't correct. This is a standard protocol used in clinical drug trials (for many drugs that have far more potential health complications than EPO).
I know what the article says. It also draws conclusions from unpublished data. The author of the article (not the study) even says that the investigators aren't revealing the data until they submit their results for publication. As such, anything related to this study is hearsay. Drawing any type of conclusion from this article is complicated since the variables are not clearly reported, as stated in my previous comments.

As for your comments about a placebo controlled trial, you are missing the point of efficacy studies related to medications. Medications are studied at doses intended to produce a specific response in a patient with a disease. Epoetin has been studied to increase red blood cells, hemoglobin/hematocrit in patients with anemia. That means they aren't increasing these to supranormal levels. If you aren't increasing them to supranormal levels, then your outcome should be similar performance as patients with normal RBCs, hemoglobin, and hematocrit. This reported study would likely increase these parameters to supranormal levels in an attempt to improve performance. Increasing your hemoglobin/hematocrit too high will increase blood viscosity and increase cardiac strain. In order to avoid this, there would have to be a monitor, otherwise you are breaking every research ethics document (rule/code/law) by introducing a greater risk of harm.

Also, if you were familiar with double blind studies, you would know that one type blinds the patients and the clinicians, but does not blind all (or some) of the investigators. Often times, investigators will only blind one person. That person will not be involved in data analysis and interpretation, but will serve as the safety monitor. So, clearly they could still conduct this study with a monitor. My question was which method they used, as some are more valid than others when considering bias.
 

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I know what the article says. It also draws conclusions from unpublished data. The author of the article (not the study) even says that the investigators aren't revealing the data until they submit their results for publication. As such, anything related to this study is hearsay. Drawing any type of conclusion from this article is complicated since the variables are not clearly reported, as stated in my previous comments.

As for your comments about a placebo controlled trial, you are missing the point of efficacy studies related to medications. Medications are studied at doses intended to produce a specific response in a patient with a disease. Epoetin has been studied to increase red blood cells, hemoglobin/hematocrit in patients with anemia. That means they aren't increasing these to supranormal levels. If you aren't increasing them to supranormal levels, then your outcome should be similar performance as patients with normal RBCs, hemoglobin, and hematocrit. This reported study would likely increase these parameters to supranormal levels in an attempt to improve performance. Increasing your hemoglobin/hematocrit too high will increase blood viscosity and increase cardiac strain. In order to avoid this, there would have to be a monitor, otherwise you are breaking every research ethics document (rule/code/law) by introducing a greater risk of harm.

Also, if you were familiar with double blind studies, you would know that one type blinds the patients and the clinicians, but does not blind all (or some) of the investigators. Often times, investigators will only blind one person. That person will not be involved in data analysis and interpretation, but will serve as the safety monitor. So, clearly they could still conduct this study with a monitor. My question was which method they used, as some are more valid than others when considering bias.

it's pretty straightforward to de-identify blood samples and test hematocrit levels, as the study presumably maintained those levels below the 50% UCI/WADA threshold. (FWIW, the evidence linking cyclists deaths to EPO in the early 90s was speculative Book excerpt: Dr. Ferrari was right - VeloNews.com ). The authors now run a clinical trials service in the Netherlands, so are presumably familiar with the standard protocols to use (it is also self-funded, so under whatever national agency governs trials and exempt from research university IRB). Supranormal parameters are also only a subset of associated risks - suppression of red blood cell regulation etc. would also have to be monitored but again that is not complicated while maintaining their double-blind protocol.

The study in question is a follow-up to a meta-analysis/review some of the authors published in The British Journal of Clinical Pharmacology, so it's not exactly as though there's no literature trail here and it's not hearsay (since the authors are reporting the results directly to the journalists). The main limitation in all these studies, however, is whether the semi-elite sample is representative of elite professional cyclists.
 

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it's pretty straightforward to de-identify blood samples and test hematocrit levels, as the study presumably maintained those levels below the 50% UCI/WADA threshold. (FWIW, the evidence linking cyclists deaths to EPO in the early 90s was speculative Book excerpt: Dr. Ferrari was right - VeloNews.com ). The authors now run a clinical trials service in the Netherlands, so are presumably familiar with the standard protocols to use (it is also self-funded, so under whatever national agency governs trials and exempt from research university IRB). Supranormal parameters are also only a subset of associated risks - suppression of red blood cell regulation etc. would also have to be monitored but again that is not complicated while maintaining their double-blind protocol.

The study in question is a follow-up to a meta-analysis/review some of the authors published in The British Journal of Clinical Pharmacology, so it's not exactly as though there's no literature trail here and it's not hearsay (since the authors are reporting the results directly to the journalists). The main limitation in all these studies, however, is whether the semi-elite sample is representative of elite professional cyclists.
When I review research manuscripts, I find that everything you assumed is not always true. I'm sure as a scientist, you have come across mistakes in protocols and procedures. Assuming is a dangerous thing when reviewing research. That is why there are methods sections in manuscripts.

Regarding the hearsay, not everything is quoted and as such, the authors of the article can describe what was told to them in their own words. This can often lead to misinterpretations. For example, look at these excerpts from the article "Half of the cyclists were injected with the drug and half with a placebo. None of them knew what they were receiving and neither did the scientists leading the research." and "These were locked away so nobody could use them to identify who had the EPO in their veins until the whole experiment was over."

Based on the first sentence, there is completely room for there to be a data and safety monitoring board to be following the patients, but if you read the lasts sentence, it suggests that nobody could see these data.

My point in all of this is that no judgement on this study should be made until the manuscript is published. Even then, one should read the manuscript closely to determine if the authors' conclusions actually match the results of the study. Until then, any stance on the subject is purely speculation.
 

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There seems to be a strong push right now to legitimize...cheating... in cycling. This article, the Velonews article about how Eddie Borysewicz was such a great guy legally doping his riders in 1984, Mark Johnson's new book on how safe doping drugs are... it's pretty disgusting.

All these lies are pushing lots of people out of cycling, including sponsors. ALL Cycling, not just the professional sport, is heading for a serious crisis of conscience and finances in the next couple of years.
 

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There seems to be a strong push right now to legitimize...cheating... in cycling. This article, the Velonews article about how Eddie Borysewicz was such a great guy legally doping his riders in 1984, Mark Johnson's new book on how safe doping drugs are... it's pretty disgusting.

All these lies are pushing lots of people out of cycling, including sponsors. ALL Cycling, not just the professional sport, is heading for a serious crisis of conscience and finances in the next couple of years.
I see Eddie B most Saturdays. He's still coaching but about to retire
 

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I took epogen last year, for about 2 months (legally, due to kidney failure and anemia). I barely had any energy before, and within a week of taking the epogen, I suddenly had strength (but not yet stamina). I actualy had to be careful about riding while I was on it, since I suddenly felt like I was ready, but cramping afterwards told me that in fact, I was not. Once my hematocrit numbers got higher, I was taken off the medication, and haven't needed it since.
 
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