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An analysis of the long-term effects of performance-enhancing drugs

Doping vs. Bad memories

Even if the effects of doping are lasting, there is nothing saying they are all good. Vaughters was surprised when he first read about this debate. “When I saw this argument that there’s this permanent change in performance, my initial reaction was, ‘Yeah, there is, but it’s negative. Doesn’t everyone know that?’”

The drug of choice for cyclists over the past decade has been EPO, and it paints a grimmer long-term picture. EPO appears to produce no structural improvements even in the short run. It does not affect capillary density, muscle size, or muscle fiber type. It does not produce the sort of benefits that last.

“What I have anecdotally noticed is that while people are taking erythropoietin — while I was taking erythropoietin — there is certainly an increased training load possibility,” Vaughters said. “But I have also noticed that when you cease taking the drug, there is a sort of backlash — since your bone marrow receptors have been over-occupied with erythropoietin, your body basically shuts down red blood cell production for a while and the bone marrow isn’t as receptive to natural erythropoietin.”

Vaughters said he has seen riders drop well below their pre-EPO baseline abilities, and claims the effect last years in some cases.

The effect is called erythropoietin hyporesponsiveness. It’s well documented in cancer patients who take large quantities of EPO to stay alive. EPO receptors become desensitized and there can even be damage to bone marrow where red blood cells are produced.

More concerning still is a condition called pure red cell aplasia. When medical patients are maintained at high doses of EPO, the body can develop antibodies against EPO itself; these antibodies are unable to distinguish between natural and synthetic forms. The result is a permanent and sometimes dangerous reduction in red blood cells.

Of course, as Vaughters pointed out, the EPO he took over his entire career amounted to about the quantity a cancer patient would receive in one month. He saw these consequences far more in cyclists who rode in the mid-90s, before there was a 50-hematocrit limit and biological passports. These riders couldn’t compete after they stopped taking EPO. For later generations who micro-dosed, he admitted that these long-term consequences were less likely.

With the potential consequences, it’s interesting that in an anonymous study of why cyclists doped, many riders said they felt they needed it for their health. They were convinced that these products were necessary to survive the rigors of such a tough sport.

Doping vs. Opportunity

While the science behind the lasting physiological effects of doping is still in its infancy and unclear, there is one way in which doping clearly has a lasting effect — opportunity.

Most cyclists who used PEDs, because of their results while doped, were able to gain access to better teams, better doctors, and better coaches, not to mention more fame and its rewards. Many still have this access.

In his book The Secret Race, Tyler Hamilton wrote about how he was finishing in the third group on the road before he started doping. He also implied that doping ruined his career. But who would buy a book from a little-known clean rider who spent his career finishing at the back of the peloton? As Olympic champion Nicole Cooke pointed out, Hamilton made more money from his book on doping than she did during a career of clean racing.

Vaughters feels that changing the sport begins by forgiving, and allowing the truth to flourish. He pointed out that by helping past dopers be honest, we can learn the patterns of behavior and how to better identify them. You’re going to get there faster “than if you condemn anyone who’s ever admitted,” he said. “What’s the motivation for anyone to ever admit?”

Ultimately, it’s up to each of us, individually, whether we want to forgive, whether we feel these cyclists have had an unfair lasting advantage, be it physiological or in opportunity.

But perhaps what’s most important is the lasting effect on the sport itself. In the study on why cyclists doped, a key reason was because of pressure put on them by the elder statesmen of the sport. Now these past dopers are the elder statesmen. They have the opportunity to do something different: To come clean, serve as lessons, and work to create a culture of clean sport for the next generation.

If they can make that the true lasting effect of their doping, perhaps we can find it a little easier to forgive.

Trevor Connor is a long-time cycling coach and researches both exercise physiology and nutrition at Colorado State University. This story originally appeared in the February 2014 issue of Velo magazine.

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