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EPO of no effect in bike races, claim researchers who staged Mont Ventoux race

48 cyclists - half on EPO, half on a placebo - raced up the Geant de Provence this weekend

Researchers in the Netherlands say that EPO appears to have no effect on well-trained cyclists in a race after they staged one on Mont Ventoux this weekend in which half the participants had been injected with the banned substance, with the rest given a placebo.

Some 48 male amateur cyclists from the Netherlands participated in the race, arranged by the Centre for Human Drug Research (CHDR) in Leiden, which is investigating “the effect of recombinant human erythropoietin (EPO) on the bike performance and potential side effects in well-trained cyclists.”

> Get paid to ride up Mont Ventoux – on EPO

The riders, none of whom know whether they had been given EPO or a placebo, had already ridden 120km before tackling Mont Ventoux during the weekend’s race.

According to a report on NOS.nl, the group that had been injected with a placebo took an average of 1 hour, 37 minutes and 45 seconds to complete the ascent, but those riding on EPO were on average 38 seconds slower.

The team carrying out the research, who launched the study because they had doubts about the performance enhancing benefits of EPO say that their initial impression from the race is that it makes no difference in a race situation, and point out that their investigation is the first to seek to gauge its impact in such a scenario.

Clearly, these are preliminary findings only, and it will be several months before the study is published in a scientific journal.

One point of note however is that among those who had been given EPO, only 38 per cent believed afterwards that they fell into that group; among those given a placebo, 74 per cent thought they had been riding with the aid of EPO.

The trial lasted three months, with participants making 15 three-hour visits to the CHDR and undergoing an eight week course of EPO or the placebo, depending on the group they fell into, while continuing to train normally.

The research facility has questioned the benefits of EPO for improving performance in cycling before.

In 2012, after Lance Armstrong was banned from sport for life, CHDR professor in clinical pharmacology Adam Cohen, writing in the British Journal of Pharmacology, insisted it was “rather naïve” to believe a race could be won solely due to a rider taking EPO.

> Study claims no evidence that EPO boosts performance of elite cyclists

Simon joined road.cc as news editor in 2009 and is now the site’s community editor, acting as a link between the team producing the content and our readers. A law and languages graduate, published translator and former retail analyst, he has reported on issues as diverse as cycling-related court cases, anti-doping investigations, the latest developments in the bike industry and the sport’s biggest races. Now back in London full-time after 15 years living in Oxford and Cambridge, he loves cycling along the Thames but misses having his former riding buddy, Elodie the miniature schnauzer, in the basket in front of him.

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Giles Pargiter | 7 years ago
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I think the main thing that one can take home from this journalistic report is that their seems from this experiment to be a strong indication that the EPO had little or no effect.

As Tommytazzer has tried to point out we don't really have enough information from this journalism to know precisely the methodology or the statistical analysis but that from what we have been told it is highly likely (especially considering who was conducting the experiment) that all the variables have been properly controlled for, and from what we do know their is no intrinsic reason that they haven't been. However without the actual published report, which will include these details of methodology and the statistical analysis used including the figures (which the reporter himself may well not understand) so that we can calculate them for ourselves. So this is just a (interesting) journalists report on what some scientists think they may find.

My only comment is that due to the number of participants in each group the findings may be a little lacking in statistical power, and so to be taken as a (strong) preliminary indicator rather than conclusive evidence.

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Colin Peyresourde | 7 years ago
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It doesn't aid recovery. Anabolic and Corticol steroids do that. You might not feel so spent on it, but you don't take it for recovery. 

I've never believed the line about one day races. It has always sounded like the last bit of self-delusion from doped up athletes not wishing to condemn their own sport.

if it takes more effort to get beyond your threshold it will help. You might be able to ride and get lucky, but EPO would definitely help. Why do you think the Mapei team placed 1, 2 and 3 in PR back in the nineties?

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Benjiboo84 | 7 years ago
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This is really poor journalism. 

 

I actually bumped into a couple of the test subjects over in Tuscany this past week, we climbed San Pellegrino together or at least I tried to. 

 

1 was clearly on EPO and knew it, the other one wasn't sure as he explained he had lost a fair amount of weight over the past year and wasn't sure if that was the real driver to his improved performance. 

 

What this article fails to cover, which is of critical importance, is that each of the subjects was given a power meter and monitored for a period before the test started. Thus only when the scientists poor over the data will they be able to make an informed review of whether or not the EPO made a respective difference in performance to each individual. 

 

Its also worth noting that the guys advised those on EPO were getting a 10% boost of what is a naturally occurring in the body. Back in the Armstrong days those guys were pumped up by 30% or more. 

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Guanajuato | 7 years ago
1 like

"One point of note however is that among those who had been given EPO, only 38 per cent believed afterwards that they fell into that group; among those given a placebo, 74 per cent thought they had been riding with the aid of EPO."

This makes me wonder - why were the placebo group so much more sure they weren't the placebo group?  To me that suggests something other than double-blind testing.

To further validate, they need to re-run the race with the groups swapped (or partially swapped). But maybe they have thought of that and its in the main output that's yet to be published.

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Skylark | 7 years ago
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The use of EPO is for multi stage races. Not a weekend jaunt.

The idea is to aid recovery. Do you know how good performances get when you're fully trained and rested at the same time? You're literally flying up terrains for 200KM+.

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leqin | 7 years ago
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I haven't got time to read the whole article and I haven't got the time spare to read everything you wrote, but out of interest what in hell have bottom brackets got to do with EPOyes

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PATMAC | 7 years ago
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Its been a while since i read Tylers book ..however my understanding of EPO use was that it was like old school tuning a car.. the  cyclists engine was already finely tuned, and the epo enabled the cyclist to dig even deeper and only then and only IF you were able to rev harder and get the results in  and over the red line so to speak.. what i took out of that is that it don't make a donkey into a race hoss..

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carlheimdal | 7 years ago
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Did Lance pay for this study?

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Tommytazzer | 7 years ago
2 likes

Blimey - there's a lot of scientific illiteracy in this thread. Let's break this down

  • Epo takes weeks to work so of course they wouldn't have just injected it at the start of the ride. 
  • Randomised placebo controlled blinded trials like this one are the gold standard study for stuff like this. The (very powerful) placebo effect is controlled for because no one knows if they're getting epo or saline injections. Nor would the scientists administrative  the drug or those recording the result. Bias is therefore minimised. 
  • This sort of study is the only way you can answer the question - does erythropoietin improve cyclist performance? Just because it should work doesn't mean it actually does (there are countless drugs in the medical world that should work but don't. 
  • The plural of anecdote is not data. Saying that you heard that your neighbours brother in law increased his threshold power by 70 watts after starting epo means very little. What about all the doping cyclists who's power didn't increase. You have no idea how many of them there are. That's what trials are for. 
  • Finally - the trial hasn't been published yet. To know whether this study is up to snuff I'd have to read the detailed methodology and look hard at the statistical methods used. 
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Rich_cb replied to Tommytazzer | 7 years ago
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Tommytazzer wrote:

Blimey - there's a lot of scientific illiteracy in this thread. Let's break this down

  • Epo takes weeks to work so of course they wouldn't have just injected it at the start of the ride. 
  • Randomised placebo controlled blinded trials like this one are the gold standard study for stuff like this. The (very powerful) placebo effect is controlled for because no one knows if they're getting epo or saline injections. Nor would the scientists administrative  the drug or those recording the result. Bias is therefore minimised. 
  • This sort of study is the only way you can answer the question - does erythropoietin improve cyclist performance? Just because it should work doesn't mean it actually does (there are countless drugs in the medical world that should work but don't. 
  • The plural of anecdote is not data. Just because you heard that your neighbours brother in law increased his threshold power by 70 watts after starting epo means diddly-squat. 
  • Finally - the trial hasn't been published yet. To know whether this study is up to snuff I'd have to read the detailed methodology and look hard at the statistical methods used. 

The use of Ventoux invalidates the whole experiment.

No two ascents will ever be exactly the same so the results will not be reproducible.

They also fail to address the role that the Athlete themselves plays.

Put me in a slightly faster car than Lewis Hamilton and he'll still beat me round an F1 track because he is so much better at driving.

Give a pro 40 more watts and they'll squeeze every ounce of benefit from it. Give me 40 more watts and I'll probably set off too fast, go into the red and blow up halfway up the hill.

Climbing successfully is not all about power to weight, there is a considerable amount of skill involved (notwithstanding variables such as weather, traffic, mechanicals etc) unless they found a way to control for that then the results are worthless.

Stick them on turbo trainers and measure their FTP pre and post EPO. That would be scientific.

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Tommytazzer replied to Rich_cb | 7 years ago
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[/quote] The use of Ventoux invalidates the whole experiment. No two ascents will ever be exactly the same so the results will not be reproducible. They also fail to address the role that the Athlete themselves plays. Put me in a slightly faster car than Lewis Hamilton and he'll still beat me round an F1 track because he is so much better at driving. Give a pro 40 more watts and they'll squeeze every ounce of benefit from it. Give me 40 more watts and I'll probably set off too fast, go into the red and blow up halfway up the hill. Climbing successfully is not all about power to weight, there is a considerable amount of skill involved (notwithstanding variables such as weather, traffic, mechanicals etc) unless they found a way to control for that then the results are worthless. Stick them on turbo trainers and measure their FTP pre and post EPO. That would be scientific.[/quote]

 

But the control and intervention group all climbed the same mountain right? As I said I'd have to read the paper, but that doesn't invalidate it. 

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Rich_cb replied to Tommytazzer | 7 years ago
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Tommytazzer wrote:

But the control and intervention group all climbed the same mountain right? As I said I'd have to read the paper, but that doesn't invalidate it. 

Unless you can guarantee that the conditions on the mountain were identical for every rider then it does invalidate the results.

Conditions at that altitude can change so quickly that even a 15 minute difference in start times can completely alter the nature of your ride.

We know EPO (when correctly dosed) increases red blood cell production (it is medically licensed for this purpose).

We know red blood cells carry oxygen.

We know muscles use oxygen when doing work.

It stands to reason that (correctly dosed) EPO would therefore increase your aerobic capacity and your anaerobic threshold/ functional threshold power.

If you really wanted to test that theory you'd just need to do reproducible indoor threshold testing on the two groups.

Even if the EPO group did increase their thresholds they may not have been able to utilise that in a real world climb due to their lack of experience.

An elite pro on the other hand would make the most of every extra watt.

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Tommytazzer replied to Rich_cb | 7 years ago
1 like

Rich_cb wrote:
Tommytazzer wrote:

But the control and intervention group all climbed the same mountain right? As I said I'd have to read the paper, but that doesn't invalidate it. 

Unless you can guarantee that the conditions on the mountain were identical for every rider then it does invalidate the results. Conditions at that altitude can change so quickly that even a 15 minute difference in start times can completely alter the nature of your ride. We know EPO (when correctly dosed) increases red blood cell production (it is medically licensed for this purpose). We know red blood cells carry oxygen. We know muscles use oxygen when doing work. It stands to reason that (correctly dosed) EPO would therefore increase your aerobic capacity and your anaerobic threshold/ functional threshold power. If you really wanted to test that theory you'd just need to do reproducible indoor threshold testing on the two groups. Even if the EPO group did increase their thresholds they may not have been able to utilise that in a real world climb due to their lack of experience. An elite pro on the other hand would make the most of every extra watt.

 

nothing "stands to reason" in physiology and medicine. Everything needs testing. An organism is so much more complicated than you seem to think - just because oxygen carrying capacity is increased doesn't mean performance necessarily also increases. Maybe the increased haematocrit cause micro obstructions in the capillary bed leading to areas of hypoperfusion. Or maybe some other unforeseen effect occurs. The point is we don't really know until we do the study. And the outcome of the study should be the thing were interested in - in this case how much faster does epo make a cyclist go up a hill. So time the subjects going up hills. Measuring their power on a watt bike is a surrogate marker of epo's efficacy. 

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Rich_cb replied to Tommytazzer | 7 years ago
1 like
Tommytazzer wrote:

nothing "stands to reason" in physiology and medicine. Everything needs testing. An organism is so much more complicated than you seem to think - just because oxygen carrying capacity is increased doesn't mean performance necessarily also increases. Maybe the increased haematocrit cause micro obstructions in the capillary bed leading to areas of hypoperfusion. Or maybe some other unforeseen effect occurs. The point is we don't really know until we do the study. And the outcome of the study should be the thing were interested in - in this case how much faster does epo make a cyclist go up a hill. So time the subjects going up hills. Measuring their power on a watt bike is a surrogate marker of epo's efficacy. 

I agree with the need to test whether increasing your haemoglobin does increase your FTP but it needs to be done in a controlled environment.

Ventoux has so many variables (that can't even be easily measured) that doing the experiment there makes it essentially worthless.

Surely you must have cycled up a hill in a headwind before? How different was it to a still day? Or a day with a tailwind? What about a very hot or very cold day?

These things affect performance so much that a gap of a few seconds between two groups becomes meaningless.

Power in a static bike is not a surrogate marker, it's a reliable, reproducible figure. You can even reproduce the effects of altitude.

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Tommytazzer replied to Rich_cb | 7 years ago
1 like

Rich_cb wrote:
Tommytazzer wrote:

 

nothing "stands to reason" in physiology and medicine. Everything needs testing. An organism is so much more complicated than you seem to think - just because oxygen carrying capacity is increased doesn't mean performance necessarily also increases. Maybe the increased haematocrit cause micro obstructions in the capillary bed leading to areas of hypoperfusion. Or maybe some other unforeseen effect occurs. The point is we don't really know until we do the study. And the outcome of the study should be the thing were interested in - in this case how much faster does epo make a cyclist go up a hill. So time the subjects going up hills. Measuring their power on a watt bike is a surrogate marker of epo's efficacy. 

I agree with the need to test whether increasing your haemoglobin does increase your FTP but it needs to be done in a controlled environment. Ventoux has so many variables (that can't even be easily measured) that doing the experiment there makes it essentially worthless. Surely you must have cycled up a hill in a headwind before? How different was it to a still day? Or a day with a tailwind? What about a very hot or very cold day? These things affect performance so much that a gap of a few seconds between two groups becomes meaningless. Power in a static bike is not a surrogate marker, it's a reliable, reproducible figure. You can even reproduce the effects of altitude.

 

I very much doubt the study design separated the control group from the epo group and made them ride up Ventoux separately. That would be almost comically inept design. Almost certainly they were sent up the hill in a random order and that randomness is what makes the test more valid. Obviously you'd have to get the number of participants right or the trial would be underpowered but there are various statistical methods to ensure that. 

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Rich_cb replied to Tommytazzer | 7 years ago
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Tommytazzer wrote:

I very much doubt the study design separated the control group from the epo group and made them ride up Ventoux separately. That would be almost comically inept design. Almost certainly they were sent up the hill in a random order and that randomness is what makes the test more valid. Obviously you'd have to get the number of participants right or the trial would be underpowered but there are various statistical methods to ensure that. 

It states in the article that "The riders... had already ridden 120km before tackling Mont Ventoux during the weekend’s race."

So they would not arrive at the mountain in any pre determined order or at the same time.

They would also already have had 120km or variable conditions prior to starting the climb.

This makes the results meaningless.

A basic requirement of study design is that the results should be reproducible.

This study fails in that regard.

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Colin Peyresourde replied to Tommytazzer | 7 years ago
1 like

Tommytazzer wrote:

Blimey - there's a lot of scientific illiteracy in this thread. Let's break this down

  • Epo takes weeks to work so of course they wouldn't have just injected it at the start of the ride. 
  • Randomised placebo controlled blinded trials like this one are the gold standard study for stuff like this. The (very powerful) placebo effect is controlled for because no one knows if they're getting epo or saline injections. Nor would the scientists administrative  the drug or those recording the result. Bias is therefore minimised. 
  • This sort of study is the only way you can answer the question - does erythropoietin improve cyclist performance? Just because it should work doesn't mean it actually does (there are countless drugs in the medical world that should work but don't. 
  • The plural of anecdote is not data. Saying that you heard that your neighbours brother in law increased his threshold power by 70 watts after starting epo means very little. What about all the doping cyclists who's power didn't increase. You have no idea how many of them there are. That's what trials are for. 
  • Finally - the trial hasn't been published yet. To know whether this study is up to snuff I'd have to read the detailed methodology and look hard at the statistical methods used. 

I think that you're right for the most part. But either the reporting above is very bad (plausible) and/or the experiment set up is not very scientific. Why would you use a mountain when an indoor trainer can reveal the results so much more effectively? Thereby removing the variables that cycling up a windy mountain at different times while on holiday might have.....

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tarquin_foxglove replied to Tommytazzer | 7 years ago
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Tommytazzer wrote:
  • The plural of anecdote is not data.

The correct quote is "The plural of anecdote is data."

Sure, just your neighbours brother in law increasing their threshold power by 70 watts is an anecdote but if my neighbours brother in law did the same, woah, that's data right there. 

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Rich_cb | 7 years ago
1 like

Time up the climb is a very poor measure of the efficacy of EPO.

There are too many variables (pacing, weather etc) to make it a fair measure.

EPO works by increasing your body's production of red blood cells. This increased production leads to each litre of blood having a greater number of red blood cells and hence a greater amount of haemoglobin (the oxygen carrying component of red blood cells).

The amount of oxygen a litre of blood can carry is directly proportional to the amount of haemoglobin it contains.

The more oxygen you can carry in your blood the more oxygen you can deliver to your muscles, this increases your anaerobic threshold.

So riders taking EPO can sustain a greater effort for longer as they remain beneath their anaerobic threshold. Aerobic work is much easier to recover from than anaerobic work so less time above threshold will lead to faster recovery times.

If they analysed the riders under laboratory conditions and found no change in VO2 max then they might have been onto something but by choosing an external climb they essentially invalidate their results.

Finally the article doesn't mention if the riders' blood tests showed any change after the EPO dosing. If there was no change in the blood tests then the EPO dose was insufficient anyway.

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risb98 | 7 years ago
3 likes

This study design is what is called a  double blind placebo controlled study. The numbers of riders may not have the power to provide statistical significance, but if designed propely, it will. Done properly this is exactly the type of study to asnwer the question they are asking. you would have to control for confounding factors such as intensity of training, but otherwise the methodology looks sound, the riders may have been paired or randomly assigned to each group. Wait for the paper to be published, not ethe quality of the journal, and then make your judgement, not before

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kevinmorice replied to risb98 | 7 years ago
0 likes

risb98 wrote:

This study design is what is called a  double blind placebo controlled study. The numbers of riders may not have the power to provide statistical significance, but if designed propely, it will. Done properly this is exactly the type of study to asnwer the question they are asking. you would have to control for confounding factors such as intensity of training, but otherwise the methodology looks sound, the riders may have been paired or randomly assigned to each group. Wait for the paper to be published, not ethe quality of the journal, and then make your judgement, not before

 

The methodology for their experiment does look sound, as far as all the statistical and experimetnal design basis goes. The problem is that the very idea of their test is stupid, that simply isn't how EPO works! It is not a one-shot, instant-action chemical.

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festina replied to risb98 | 7 years ago
0 likes
risb98 wrote:

This study design is what is called a  double blind placebo controlled study. The numbers of riders may not have the power to provide statistical significance, but if designed propely, it will. Done properly this is exactly the type of study to asnwer the question they are asking. you would have to control for confounding factors such as intensity of training, but otherwise the methodology looks sound, the riders may have been paired or randomly assigned to each group. Wait for the paper to be published, not ethe quality of the journal, and then make your judgement, not before

I agree. I have a feeling that there is only half a story here. It seems unclear on how the results were evaluated. Average speed between the two groups would seem odd as the variance between the two groups could be larger than the benefit however if you assume that they are a similar bunch then this variance is reduced by taking average speed.
In addition it seems they wanted to evaluate effect on racing rather than individual effort so I guess this was a bunch race to the top. After all the effects of epo on an individual system have been reviewed a number of times before but not the actual effect on a race situation.
From the article it's difficult to understand what conclusions can be drawn apart. Just Remember drugs don't work and no one has been kicked off a race for taking a placebo.

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Gasman Jim | 7 years ago
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There's something not right about this "study".

Last month I completed the "Mont Ventoux Cingles" challenge. This involves climbing and descending all 3 tarmaced routes to the summit in the same day. On the first ascent I actually pushed my wife up most of the way, on the last two I was riding solo. Yet even my final climb of the day (the longer, more gradual route from Sault) only took an hour and a half.

I'm just a 45 year old 70kg club cyclist, although I do quite a lot of climbing since I live in North Wales.

I don't know what kind of training regime this study involved, but it wasn't that effective, regardless of the use of EPO!

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Must be Mad | 7 years ago
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As far I understood, EPO was/is used to improve recovery, so that you can ride harder day in/day out.

Also, with  LA, there was the blood transfusion thing as well...

 

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barbarus | 7 years ago
2 likes

What I want to know is, how much faster will I be with a hidden motor and on EPO?

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Paul J | 7 years ago
0 likes

There's obvious control issues if all their comparative performance data is pitting one group of ~20 riders against another on one stage. E.g., it could be the placebo group just happened to have much stronger riders to start with.

To make this a bit better they should have at least done a cross-over study. So the members of each group should have both gone through placebo and EPO phases (and some in one order, others the other way), so that aggregate individual improvements could have been determined - while controlling somewhat for time-of-year effects.

The Uni. of Glasgow WADA "micro"-dose EPO study used that methodology, and as far as I know their preliminary results showed benefits to EPO. Though, I'm not aware of them having published yet.

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Colin Peyresourde | 7 years ago
5 likes

Jesus wept. Some people need to re-read this article again. They dosed them for weeks in advance, so they didn't just turn up, jab them and told them to ride.

Though, what dose they gave them will have impacted the result. If they gave a low dose then the body might adapt to the input and shut off its own EPO production, so in the end the benefit is nil. You have to 'overdose' so that it keeps the level jacked.

Taking EPO is different to a BB - you quote Hamilton's book and he makes this clear: on EPO it's effortless, with a BB you feel like crap, but can still churn out the big wattage so that feeling is not really in point.

The whole thing just seems like a spurious jaunt to Province. Good effort.

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davel replied to Colin Peyresourde | 7 years ago
2 likes
Colin Peyresourde wrote:

Jesus wept. Some people need to re-read this article again. They dosed them for weeks in advance, so they didn't just turn up, jab them and told them to ride.

Indeed; this comments thread reads like an advert for reading comprehension classes.

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Jacobi | 7 years ago
0 likes

"The riders, none of whom know whether they had been given EPO or a placebo, had already ridden 120km before tackling Mont Ventoux during the weekend’s race."

 

Maybe they should have given them the EPO at the start, and not after 120km? I doubt if Armstrong stopped after 100km or thereabouts to inject. He'd have had it in him from the get go. Maybe that's where the difference lies?

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drosco | 7 years ago
1 like

You'd assume if people were and still are risking their careers taking it, then there's probably something in it.

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