EPO Deaths as Urban Legend?

Were the rumored deaths of pro cyclists in early 9Os ever verified? Or was it an urban legend on steroids or Epo or whatever?

— Michael Joyner (@DrMJoyner) August 29, 2016

On Twitter, Dr. Michael Joyner asks the question above. Are oft-repeated stories of an epidemic of EPO-related deaths just urban legend or is there some substance to them?

In 2011, Professor Bernat López took a close look at the claims of an EPO death epidemic based on a review of deaths of elite cyclists in the late 1980s and early 1990s. Here is what he concluded:

The available evidence rather suggests that this series of deaths has been artificially concocted and even inflated in absolute terms and, most importantly, that it is highly improbable that EPO had anything to do with these cases, principally because there is very little, if any, scientific evidence that EPO causes sudden death. It should therefore be considered more of a myth or an invention than a historical fact. A myth which in the last years has played a central role in the ‘scaremongering tactics’ of the anti-doping campaigners, who until the early 1990s were rather short of casualties that might be attributed to doping ‘abuse’. In this sense, EPO could be labelled as the drug of mass destruction in the war on doping.

A total of 61 academic and journalistic texts have been reviewed that mention these deaths. My own research has recorded 17 sudden deaths among cyclists being reported in the six years between 1987 and 1992, including 9 Dutch and 6 Belgians. I have argued that, given the lack of statistical reliability of these data and the ‘Dutch and Belgian’ bias resulting from the news focus of the time and the search premises themselves, it cannot be reasonably said that they constitute a ‘suspicious statistical aberration’. But even if awarded credibility, this idea can be refuted after a comparison with data from other, statistically-based studies on sudden death in athletes.

Arguably, then, what has really been going on here is a double process of invention. One invention concerns the achievement of a ‘suspicious’ statistical series of deaths through the aggregation of isolated cases from two different countries during an elastic time span. The second one consists in isolating EPO as a ‘key suspect’ on the basis that it began to be released by the time this ‘spate of deaths’ was taking place. No further evidence is brought forward other than this coincidence and the common-sense-based contention that if EPO thickens the blood, too much thick blood ‘will kill you’. When going into more detail, most of the experts sustaining these theories explain that EPO abuse might cause blood clotting, hyperviscosity and hypertension, which would provoke fatal heart strokes or embolisms. But the truly scientific literature, the one based on experimental case studies, reviewed in this research does not support these claims.

López, B. (2011). The invention of a ‘drug of mass destruction’: Deconstructing the EPO myth. Sport in history, 31(1), 84-109.

What is going on here? The pattern appear to be an example of what Norwegian researcher Ole Bjørn Rekdal calls an "academic urban legend." He writes:

Many of the messages presented in respectable scientific publications are, in fact, based on various forms of rumors. Some of these rumors appear so frequently, and in such complex, colorful, and entertaining ways that we can think of them as academic urban legends. The explanation for this phenomenon is usually that authors have lazily, sloppily, or fraudulently employed sources, and peer reviewers and editors have not discovered these weaknesses in the manuscripts during evaluation. 

 López suggests that the EPO myth is also a convenient one for anti-doping agencies. However, as Paul Dimeo has written about the myth of Knud Jensen:

WADA holds itself out as being a bastion of ethics, promoting health and fair play, protecting athletes, and tackling unethical behaviour. The way in which Knud Enemark Jensen has been treated since 1960 and the contemporary refusal to redress that mistake (now that we have a revisionist perspective) undermine the essential qualities about humanity and sport that the anti-doping movement claims to uphold and promote.

It casts a shadow over WADA’s reputation, and that of the previous generation of anti-doping doctors, authors and academics. Any movement becomes compromised if its acolytes come to imagine the cause to be greater than the individuals and when they are prepared to undermine their own ideals in order to make a point.

In anti-doping, evidence matters.