Can EPO Kill?

Introduction

Once in a while I read a magazine article that gets my dander up.  In such cases I may offer a rebuttal in these pages, not because my readership is vast, but because the offensive writer might see my post and decide to go toe-to-toe with me.  I’d love that.

In this post I take on Mark Johnson and his VeloNews article titled “Book Excerpt:  Dr. Ferrari Was Right,” published on July 8, 2016 and updated on March 15, 2017.  The title refers to the disgraced cycling team doctor Michele Ferrari and his infamous quote about recombinant human erythropoietin (EPO), the drug of choice among cheating cyclists, being no more dangerous than orange juice.  Johnson makes the interesting observation that while EPO use is widely associated with death by heart attack, no causality has ever been established.

If this observation had been made in a brisk 200-word essay, I’d be grateful for it—I appreciate having a myth debunked.  But Johnson’s annoying and tedious 6,500-word article goes way too far, slinging mud at anti-doping journalists and anybody else who still thinks cheating is lame.  Read on as I savage Johnson’s essay.

Repetition as a rhetorical technique

In  junior high we all learned the basic essay formula:  state your thesis; support it through a number of examples; then restate it in your conclusion.  Those of us lucky enough to get more advanced instruction learned to mix this up a bit.  For example, you might skip the up-front thesis statement, presenting information that gradually leads the reader to come to your thesis on his or her own; following this, you can state your thesis at the end or even leave it merely implied.  Most good nonfiction writing does some version of this.

Johnson, however, gets to the point early on and then beats us over the head with his assertion, no fewer than 16 times by my count.  He starts with this:  “While the Dutch riders Rouet referred to were never conclusively linked to death by EPO, the fabrication served a larger anti-doping moral agenda and the missionary effort to impose purity on sport.”  As he develops his essay he reminds us of his position again and again.  Here are some examples: 

• “The story’s claim that the drug was responsible for 18 cyclist deaths was based on speculation”
• “What was not provable in 1991, or today, is that the drug killed a rash of cyclists”
• “EPO deaths made for good news stories, even if there was no autopsy evidence that EPO was actually killing cyclists”
• “No evidence exists to support the claim that EPO caused any of the cyclists’ deaths in the early 1990s”
• “Turning back to the EPO fiction”
• “While there is no evidence directly linking EPO to any competitive cyclist deaths in Europe”
• “The EPO-kills fabrication”
•  “The fictional nature of drug-death stories”

Okay, we get it, dude!  It’s almost as though Johnson is hoping by sheer repetition to get our heckles up against this confusion of anecdote with science.  I might start to feel annoyed by all the journalists who conflated correlation with causality, except I’m far more annoyed by Johnson’s logorrhea.  Fine, state your thesis at the beginning and the end, maybe even at the 3,000-word point just in case we forgot.  But 16 times?  What, do you think your readers all have ADHD?

Bludgeoned by evidence

To Johnson’s credit, he does back up his assertion by citing many articles that promote the EPO-equals-death idea without providing solid evidence.  A couple of illustrative examples, and allusions to other articles, would have convinced me that this unproven assertion is widespread.

Unfortunately, Johnson feels the need to bolster his case again and again, delving at length into seven different articles, along with a painstaking analysis of the matter by Bernat López, a Spanish professor similarly fascinated by the tendency of journalists to perpetuate one another’s hasty conclusions.  López must have even more time on his hands than Johnson, as he did a “meta-analysis” of 56 “academic texts” on this issue:  36 citing the dangers of EPO, and 20 arguing against the claim that EPO has killed cyclists.  Johnson blathers further by restating López’s conclusion—that no hard evidence causally links EPO with cyclists’ deaths—four times.

How much evidence do we need?  This overabundance of refutations turn Johnson’s article into some kind of journalistic Whack-A-Mole.  Okay, fine, nobody has proven EPO is deadly!  We get it!  Why go on and on like this? 

The answer to this question, I assert, is that Johnson wants to lead us toward a more subtle thesis, which he doesn’t support nearly so well, and which ultimately pisses me off.  Let’s sneak up on this hidden agenda by exploring some more of Johnson’s journalistic missteps.

Sensationalist language

Throughout his story, Johnson does a most curious thing:  while paraphrasing other journalists, and insinuating that they’re resorting to sensationalism, he employs sensationalist language of his own, again and again.  When he occasionally quotes an article directly, I see a striking disparity between the other journalist’s language and Johnson’s.  For example, a New York Times writer states that “the consequences [of EPO abuse], in some cases, may be deadly.”  Johnson sums up the article with this zinger:  “The New York Times startled readers with news of a killer stalking the roadways and velodromes of Europe.”  A killer stalking the roadways?  Seriously?

A caption in the same Times article read, “Mr. Draaijer’s widow believes that the drug recombinant erythropoietin was involved with his death.”  The Times later ran a correction, acknowledging that this caption reflected mere speculation on the widow’s part.  Johnson’s conclusion:  “Despite the correction, the rumor was already set:  EPO was a new drug of athlete destruction.”  Johnson, calm down!  Stop being so dramatic!

Here are some other examples of Johnson’s bombastic language:

• a killer set loose among the peloton
• scary new athlete killer
• a mass killer
• Grim Reaper haunting bike races and marathons
• press-supported notion that EPO was indiscriminately slaughtering cyclists in the early 1990s
• EPO’s black reputation in sports as a drug of mass destruction
• colorful, body-strewn doping history

By employing this kind of language when paraphrasing the articles he denounces, Johnson is committing an aggregate “straw man” fallacy:  he presents a weakened (in this case exaggerated) version of his opponents’ arguments in order to knock it down.

Johnson doesn’t include hyperlinks to the articles he cites, and I couldn’t find all of them, but I did check out the New York Times article.  Nowhere did I find anything like Johnson’s hyperbole.  I found responsible, carefully worded but qualified assertions:

• Doctors and blood specialists say the drug may be implicated in the deaths of as many as 18 European professional bicycle racers in the last four years
• Only anecdotal evidence links EPO to these deaths
• An autopsy did not specify the cause of death

I also happen to have clippings from two other articles on this topic.  While they both do suggest a link between EPO use and death, their wording is also cautious and understated, exactly as you would expect from a responsible journalist.

For example, “Cycle of Tragedy” by Ron Kroichick in the San Francisco Chronicle, May 9, 2004, states, “The absence of definitive causes ... underscores long-standing suspicions about performance enhancing drug use in cycling.”  While his article suggests a link, Kroichik never uses sensational language like “scary new athlete killer” or “drug of athlete destruction.”

Similarly, in “The Hardest Test,” in The New Yorker, August 21, 2000, Julian Barnes writes, “The assumption was that [the athletes’] heart rate had dropped during sleep and became simply insufficient to pump the blood. To counter this, EPO takers were said to get up in the middle of the night to exercise.”  Note the careful language here:  “the assumption was” and “were said to.”  Barnes doesn’t even assert that these reports can be proven. They lend themselves reasonably well to hearsay, but not to being substantiated.  After all, what athlete would go on record saying, “Yeah, I get up to exercise during the night because of all the EPO I take”?

An inconvenient truth

While Johnson derides the idea that EPO killed athletes, he does concede that the notion isn’t far-fetched.  He quotes hematologist Dr. Allan Erslev as saying, “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.”

Beyond this—and flying in the face of his earlier naysaying—Johnson concedes, “My own search of medical literature finds plenty of warnings about the dangers of too much EPO…. 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.”

Now, wait a second here.  If we have substantiation of the various claims that EPO thickens the blood, and medical research does show a link between EPO and heart attacks, is the implied causality in the death of these cyclists really so absurd?  Is it really “fictional,” a “fabrication,” a “fable,” and a “myth”?  Johnson makes no effort to explain why nothing has been proven in the case of cyclists, as though EPO’s risks didn’t have solid medical evidence behind them.

Does it really not occur to Johnson why this evidence doesn’t exist?  Has he not considered that team doctors of deceased athletes would prefer to sweep their EPO use under the carpet?  Has he not contemplated that when a cyclist dies and his family is grieving, no authority wants to step up and say, “Hey, if it’s any consolation, this guy was a lying cheating scoundrel”?  The governing body of cycling, meanwhile, has been infamously good at looking the other way when it comes to doping.  So the real question is, who exactly was supposed to come forth and investigate these deaths?

Sure, journalists would love to cry foul, but how are they going to gain access to damning evidence?  Who is going to let them snoop around the cyclist’s deathbed?  Johnson complains when an autopsy isn’t carried out (“there was no autopsy evidence that EPO was actually killing cyclists”), but as the Times writer pointed out, this causality cannot necessarily be established by an autopsy.

Meanwhile, what other explanation has been offered? If EPO didn’t kill these athletes, what did?  Did they drink milk from rbGH-treated cows?  Did they microwave food in plastic containers?  Did their parents just not love them enough?

(Johnson does offer up one theory, suggested by López and his survey of EPO research:  “If the researchers behind the 20 papers came up with any one Grim Reaper haunting bike races and marathons around the world, it was the damaging effect of extreme and prolonged training.” Well, isn’t it easier to train yourself to death when you’ve used EPO to speed your day-to-day recovery?  Maybe the relatively slow replacement of red blood cells is nature’s way of giving athletes the rest they need.)

Is death the only reason to condemn EPO?

Okay, let’s set aside the possibility that EPO has actually killed anyone.  Let’s assume, for the sake of argument, that EPO is never fatal.  Does that mean it’s okay?  Is that what Johnson is trying to say?  He seems inclined to vindicate the illegal use of this drug.  His vitriol verges on mocking the antidoping effort—not its efficacy, which is an easy target, but its very aim.

The height of this strange attack is a statement Johnson cites from López:  that “because the general public is largely indifferent to the drug-regulating policies that are the bedrock of anti-doping organizations, anti-doping missionaries played up the deadly EPO myth as a way to gain sympathy from a public that has an otherwise insatiable appetite for legal and illegal performance- and lifestyle-enhancing drugs.”

Granted, this is López’s assertion, but because Johnson trots it out (without calling it out as the raving of an obvious dipshit), he seems to agree.  WTF?!  Since when does the public have this insatiable appetite for drugs?  I don’t!  I want to see clean athletes!  The anti-doping “missionaries” (you can just hear the contempt in López’s voice) have had my support (or “sympathy,” if you must) all along.  I don’t agree that the public is against doping controls, and moreover I don’t believe that the public would demand the risk of fatality as a prerequisite for getting on board with an end to doping.

To his credit, Johnson does a fine job of explaining how EPO overrides the body’s natural ability to regulate blood cell production.  But he doesn’t seem to grasp, or at least acknowledge, that this is a very scary proposition.  Perhaps he never read Matt Rendell’s chilling article about Marco Pantani, “The Long, Lonely Road to Oblivion,” in The Guardian (March 7, 2004).  Check out this bit about what doctors found when, after a terrible crash, Pantani was admitted to an Italian hospital for multiple compound bone fractures: 

On his arrival at Turin’s Centro Traumatologico Ortopedico at 3.20pm, doctors were startled to discover blood values that were abnormal, almost bizarre: his haematocrit, or red cell count, was 60 per cent (50 per cent is high); his haemoglobin was 20.8g per 100ml (18g is noteworthy). These values then plummeted: on 25 October, with 15.9 per cent haematocrit and 5.8g haemoglobin, it took a transfusion to save his life.

After which the anaemia miraculously cleared. Someone, it seemed, had injected Pantani with the genetically engineered blood-booster erythropoietin, known in sport as the doping agent EPO. At the age of just 25, Pantani’s body had grown so dependent on these injections that it could no longer produce red blood cells.

Oh. My. God.  To tamper with the body’s ability to regulate blood cell production doesn’t sound safe whatsoever, whether it actually kills you or not.  Why does Johnson hold out for proof of fatality?  Isn’t EPO scary enough as it is?

What really gets me about Johnson is his scornful attitude toward the anti-doping mentality, and his insistence that raising suspicion about unsolved deaths in the EPO era is somehow more irresponsible or unfair than the EPO use itself.  “The fiction served as propaganda,” Johnson whines, “that made it professionally and personally suicidal to challenge the morality and righteousness of the antidrug movement.”  Isn’t the antidrug movement intrinsically moral and righteous?  On what moral ground could a cyclist challenge drug controls?  Do we have a God-given right to cheat by using dangerous drugs?

I struggle to understand what Johnson is really after here.  What version of cycling would he prefer?  A sport where those willing to take the greatest risks to their health (and their livelihood) are allowed to dominate, with a crushing, tactically minimalist style of putting all their doped teammates at the front of the pack and grinding everybody down until nobody is left to challenge their doped-to-the-gills leader?

I love this sport because, as a former racer with a sadly meager hematocrit, I found ways to succeed through grit, perseverance, patience, teamwork, and tactical acumen.  As such, I want to see all kinds of racers have a chance, not just those who respond particularly well to drugs.

For Johnson to attack the anti-doping movement, on the basis of insufficient evidence of EPO’s role in the deaths of cyclists, is seriously off-base.  I’m offended by his snide attitude, his bombastic and sensationalist language, and his audacious attempt to claim the moral high ground.  I hope Johnson’s book tanks, and that nobody mistakes his dogged rhetoric and tedious repetition for actual logic, judgment, or insight.

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