The EPO Epidemic in Sport

Hein Verbruggen
Union Cycliste Internationale
Lausanne, Switzerland

It is interesting to note that performance-enhancing drugs have been used since the beginning of organized sports. There is evidence that such substances were used as early as the 4th century B.C., at which time there existed substances and methods to create feelings of euphoria, decrease fatigue, and increase strength.

With the advent of modern organized sporting activities ˆ dating back to the 19th century ˆ has come ever-increasing interest in superior performance. The ability to accurately measure time and strength contributed to this interest, and the lure of prizes and fame led to the undertaking of sports as a profession.

Notably, in recent decades there have been well publicized increases in the use of new synthetic substances, including morphine, codeine, amphetamines, anabolic steroids, and corticosteroids to increase performance. There has also been a strong trend toward increased use of dietary supplements.

Most recently we have seen the introduction of synthetic peptides such as erythropoietin (EPO) ˆ the first substances that have quantifiable impacts on athletic performance, and which are very hard to detect.

Since the introduction of these substances, we have seen significant performance increases, as evidenced by the rate of new world records being set in endurance sports, such as swimming, cycling, and speed skating.

Prior to the introduction of synthetic peptides there was no real scientific evidence that other drugs used in the athletic community, such as amphetamines and steroids, had any measurable effect on endurance. This changed, however, with the introduction of EPO, which can enhance performance in some tests of endurance by as much as 20 percent.

This problem of doping in sports may well have something to do with the general medicalization of society. More and more pharmaceutical products are taken and have become almost a normal part of life. There is also an idealization of success ˆ that it should come at almost any price. These pressures to perform at the highest possible levels exert a powerful stimulus on athletes to use performance-enhancing substances.

To many of us involved in sports professionally, it is a given fact that every athlete seeks to enhance their performance. Whether they do it with legal products ˆ those not on the list of forbidden substances for their sport ˆ or they do it with forbidden products, the goal of performance enhancement is the same.

This drive for performance has resulted in increasing use and abuse of legal drugs, particularly in those countries where doping control is very tough. The use of these products is allowed within certain limits.

Use of performance-enhancing substances has somewhat of a Œsnowball‚ effect. When one athlete does it, others feel forced to do the same thing, because they feel themselves to be at a disadvantage when competing against others who use such substances. They, quite simply, don‚t want to be at the mercy of others‚ use of these substances, which is how they feel.

My federation ˆ Union Cycliste Internationale (UCI) ˆ began its fight against doping in 1965 after we had a cyclist in the Olympic Games in Rome whose death was linked to the use of performance-enhancing drugs. We established our first anti-doping rules in 1965, and have continued our anti-doping efforts to the present day.

When UCI began testing its athletes in 1965, approximately 25 percent of 250 athletes tested positive for doping. This usage level decreased significantly and rapidly following the implementation of control measures. In contrast, UCI tested approximately 5500 athletes in 2000, out of which 1.12 percent of results were positive. It should be noted that this later statistic does not necessarily mean that there is not a higher prevalence of doping ˆ only that, perhaps, there are substances being used which are, as yet, undetectable.

Also in 2000, approximately 8000 anti-doping tests were conducted by various national and international sports federations. The majority of substances detected were light stimulants.

It should be mentioned that, in addition to purposeful doping by athletes, we are faced with the problem that more and more forbidden substances are being found in food products that are for sale in normal retail outlets. This has led to an increase in the number of athletes who test positive for doping, but who have not knowingly taken any doping agents.

In January, 1997, my organization, the UCI, introduced a health protection program to address the doping problem ˆ specifically that of EPO.

This program consisted of two steps, the first of which involved conducting blood tests prior to races. Three hours prior to a race, small blood samples were obtained from our athletes. Any athlete who had a hematocrit level over 50 was removed from the race and given a two-week rest period. These athletes with a hematocrit result over 50 were not suspended, per se, because we could not prove that the elevated hematocrit was due to EPO use. These athletes were tested again after the two-week rest period and allowed to resume competition if their hematocrit level was below 50.

The second part of our program was a medical monitoring system introduced in January 1999, which was carefully developed with both physicians and lawyers. Under this system, our athletes go through certain medical checks four times per year. This monitoring system is followed very carefully to ensure that our cyclists are able to perform safely in a sport that is very physically demanding.

It is important to note that this two-part health-monitoring program is conducted with the full consent of the athletes.

Again concentrating on EPO, which increases oxygen transportation through increasing the number of red blood cells, we have cutoff hematocrit levels of 50 for men and 47 for women. Detecting increased hematocrit is done through a relatively simple and rapid blood test, but again, this cannot prove that an athlete has used EPO.

Of course, while the measurement of hematocrit levels is an indirect method of testing for blood doping, we also have the direct urine test method currently being developed in France. The urine test, as a direct method, can prove the presence of EPO, and a positive result can, therefore, be used as the basis for sanctioning an athlete. This method also has disadvantages, namely that it has a limited detection period of 2-3 days following the injection of EPO, and it can only be performed at a few laboratories worldwide, at present.

Our anti-doping efforts have resulted in a rapid decline in the number of our athletes who test positive for various forbidden substances. These efforts have also been very expensive. We spent a total of $2.2 million in 1999 and $2.4 million in 2000 on these anti-doping efforts. The costs were, however, justified in that they protected the health of our athletes and helped to ensure the validity of our athletic performances.

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