I can believe that it's true, at least within the protocols of the experiment.

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I like that after the study was published this little gem was left by a professor unaffiliated with the study"Professor John Brewer, an expert in applied sports science at St Mary’s University College,cautioned that the benefits of improved oxygen uptake might be more pronounced in professional cyclists than in amateurs and said EPO should remain banned."


So this prof is just stating this as fact without any research of his own?


I'm remember being shouted down here on ST a few years ago when I asked if there were any studies like this.

I'm interested to see if other studies will be done along these lines.

When someone says "might" that means that they are not stating it as fact, rather, a possibility.

It's pretty standard stuff in research to talk about where the boundaries of the study may lie.

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Apparently the authors forgot about the blood doping and testosterone that he also used...

A single study, even if published in a peer reviewed journal, means nothing. It takes a lot of studies to be able to determine a trend. As a former professor of mine would say, once is a fluke, twice is a coincidence, and you can't begin to find a trend until the third consecutive time. I don't feel like finding the study in Lancet, but was it double blinded? Did they compare randomized performances of each individual with EPO vs placebo? N=48 is not enough for a clinical endpoint study.

True, but this is the only study of its kind. It is plausible (in normal people, blood returning to the lungs is not even close to fully desaturated of O2).

More studies needed.... yada yada. But it is plausible.

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If you're interested ignore the media articles and read the study which is available free at http://www.thelancet.com/...(17)30105-9/fulltext

My amateur comments:
1. This is an underpowered study. That is, the wide range of performance of the individual cyclists means that 48 is not enough to show up anything but very big differences between the two groups.

2. Have a look at this chart of Pmax (ramp test) and threshold power - would you rather be racing against the blue or the red group? Note the big variations within groups ('error bars').

3. They reported a statistically significant 5% increase in VO2max reported to increase from 57.5 to 60.

4. For threshold power the EPO group is about 3% higher +-3%. To me that shows study is underpowered (too little data to be sure) but suggestive of a benefit of a 2-5%.

5. There is no difference in the Ventoux race result but the confidence interval is +-9%, so to see a difference the EPO group would have had to be about 9mins quicker (average 1hr 40mins).

My opinion is that its complete bullshit to say from this EPO doesn't work. Whether a cheat would be happy with 3% improvement I don't know, but it would take a pro from 6 to 6.2W/kg plus whatever extra benefits of higher training load etc.

Geez, Lance will stop at nothing to clear his name. Using the alias Henry Bodkin is going too far...

All good points plus a couple of additions:

1) Dosing 1 x per week is lower than even the "recommended " dose.
2) 8 weeks is not enough time
3) increases in maximal power lead to increases in sub maximal power over time

3 PERCENT?! That's massive... Some years, over nearly 100hrs of racing, the TDF is won by less than a minute. And sometimes by less than 10sec.

At the last tour, the difference in winning time was 4min - or 7/100ths of a %. So in that context, 3%? Yeah, that's massive.

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It's terribly underpowered. While I respect the authors for their robust methods*, you need about 100 in each arm to reach the level of power that allows you to determine significant differences in small effects (1-5%). That's a much more difficult sample, but nobody said science was easy.

As you note, professionals would be very happy with a 3% increase in maximum power or sustained power. That's just under a minute of advantage on a 30 minute climb, or a few seconds in a sprint. That's the difference between a domestique and a team leader.

These are very interesting results, but once against scientists are mistaking lack of significance for lack of effect.

*I imagine a bunch of men and women with white coats at cycling clubs asking people if they want EPO.

EDIT:

"This study shows that clinical studies with doping substances can be done adequately and safely and are relevant in determining effects of alleged performance-enhancing drugs."

That's actually the major finding. I imagine this will spur subsequent studies of restricted performance enhancing substances, and follow up studies expanding on this one.

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A south african friend of mine took part in some research years ago with a well know scientist, he was already fit and was running 37 mins for 10k, at the end of the program he was transformed into a sub 35min 10k runner which is absolutely unbelievable difference.

I think we all react differently to drugs and some maybe like LA are super responders.

Some established Sp.Scientists pointing out the holes in the study on twitter.

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Just a thought that I wanted to bounce off you guys:

So they were unable to reject nulls on each individual day, but would it be appropriate to aggregate the data?
Basically testing a null of: is there a difference of power output between days 0-53?
As opposed to what appears to be: is there a difference of power output on day 11, 25, 39, or 53.
Given the new null, what is the likelihood they would've had the directional deviation they observed on day 11, 25, 39, and 53.

Aren't there good and bad responders? From my previous reading on EPO, if you have a naturally high RBC (48% say), then you don't have much room to benefit. If you're naturally low (42% like a lot of endurance athletes) then you have a lot of room.

Also 5hrs/week is the minimum to keep up fitness - need to do a bit more to improve, drugs or no drugs. unless you're a natural athlete or a sprinter who only does crits.

I'm not disagreeing that 3% isn't substantial, but you can't take time delta / entire tour time as an indicator of the % difference among GC contenders. The portion of the entire tour that they are even trying to separate from each other is pretty small Also, the peloton masks differences among individuals. The amount of time on the final climbs of uphill finishes + TT would be much more relevant.

The fact that the red and blue lines both lie inside both error bars means that one can consider them to be pretty much equal, correct?

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No. It means that the study was underpowered (it didn't have enough people in it to allow you to detect the kind of difference that EPO is likely to give you, with the kind of certainty you'd like).

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'It never gets easier, you just get crazier.'

No. As georgd said, it reflects that the study is underpowered.

But you can still learn a lot from this chart. The 'error' bars are actually the standard deviation - in laymans terms that is a measure of the range of powers for the riders in the EPO and placebo group. Despite this big spread, the difference in averages can be less and in this case the VT1 difference is statistically significant while the Pmax is 'nearly significant' (p=0.055). So to a certain extent we don't know. But as I said, its really clear to me which group would be tougher to race.

Yep, wonder how they got that work accepted with that thin sample size and a not really that great study protocol.

But they got the publicity and that's probably all they were going for anyway.

Edit: Sorry, just saw that someone made this same point.

You can't compare the 3% to the 7/100ths. The TdF is not a really long time trial. That 4 min difference occurred in TT stages and a few attacks. 90-something percent of the time guys are just rolling along at "tempo" pace. Point being that Chris Froome probably is probably way, way more than 7/100ths percent better than Bardet at time trialing and critical climbs.

I agree completely that 3% is huge. Just not that you can compare it to total GC time differences.

I don't think you know 48 isn't enough until you try more. E.g. the people here claiming it's underpowered are really only speculating that it is. The other alternative is that there is really no effect.

What I don't understand is the protocol. T hey divided the 48 into two groups, gave half of them EPO for 8 weeks, then sent them up the mountain.

I don't get that. There's no baseline, as described. It seems the right thing to do would be to send all 48 up the mountain clean. Then inject them all, half with EPO, half with placebo. Then send them up a second time. And compare the differences in all the riders between the baseline run and the test run.

Otherwise you'd have no way of knowing if your division actually selected an underperforming group that was actually brought back to equal performance by EPO.

The combination of a wide spread of power (eg Pmax spread more than 4.0 - 4.7W/kg) and an effect size less than about 5% means the study is under powered. My quick calculation (I'm not a statistician but I know the basics) is that given the standard deviations in participant performance the study would need 90 riders to be adequately powered to see a 5% improvement and 200 to reliably detect 3%

They did also measure various power thresholds before and after. See the chart I posted above for example. There is evidence for an effect in these measurements. For example they saw a statistically significant VO2max increased by 2.7 +- 1.8 ml/kg.min (about 4.5%).