Delivered-To: Date: Mon, 27 Jul 1998 04:02:53 -0700 (Peter Webster) To: Subject: #O# IHT: Epo: A Powerful, Dangerous Drug Sender: (Peter Webster) Pubdate: Mon, 27 Jul 1998 Source: International Herald-Tribune Contact: http://www.iht.com/ Author: Jere Longman, New York Times Service EPO: A POWERFUL, DANGEROUS DRUG Epicenter of Scandal Stimulates Production of Red Blood Cells For patients suffering from anemia caused by kidney disease, use of the synthetic hormone erythropoietin, or EPO, can be a lifesaver because it stimulates the production of red blood cells. For endurance athletes, the increased oxygen-carrying capacity provided by EPO has made it an alluring, performance-enhancing drug although it is banned and can leave athletes at risk of strokes, heart attacks and even death. EPO is at the epicenter of a widening drug scandal in the Tour de France. It is thought to be widely used in cycling, distance running and Nordic skiing by world-class athletes. But the drug goes largely undetected because scientists have yet to develop a reliable test to differentiate naturally occurring EPO from the genetically engineered version of the hormone. "And we're probably not really very close," said Dr. Don Catlin, who runs the Olympic drug testing labomtory at the Univasity of California at Los Angeles and who is a member of the International Olympic Committee's medical commission. "It's a terrible problem," he said. The synthetic version of EPO was approved by the Food and Drug Administration in 1989 for patients with specific diseases, according tothe U.S. Olympic Committee's drug education handbook. But it has been available in Europe since 1987 and has concerned Olympic officials since the 1988 Winter Games in Calgary, Alberta. Evidence of the use of EPO as a performance-enhancing drug has been most visible and ominous in cycling, where approximately two dozen deaths have been linked anecdotally to the drug since the late 1980s. EPO is a glycoprotein, or proteincarbohydrate compound, which is produced by the kidneys and circulates through-the bloodstream, stimulating the bone marrow to produce red blood cells, which in turn carry oxygen to the muscles. The drug is synthetically produced for use by patients with kidney disease, AIDS and cancer, according to the Olympic Committee handbook. Endutance athletes inject EPO to increase the number of red blood cells thus providing themselves with greater aerobic capacity. The use of EPO is the evolution of another procedure, called blood doping or blood packing. Blood doping involved an athlete removing a portion of his blood, allowing his body to replenish its redblood cell supply, then intravenously restoring the removed blood to increase his oxygen-carrying ability. Both procedures are banned because they give athletes unfair competitive advantages, and both carry health risks. The danger with EPO is that an excessive number of red cells thickens the blood, especially with the dehydration that results from strenuous exercise, making it more difficult for the heart to Dump blood through the body. This ieaves athletes atrisk of clotting, strokes and heart attacks, Dr. Catlin said. "If you give a kidney patient EPO, it remarkably improves the quality of their life," he said. "But it's a two-edged sword, and the edges are very sharp. " Over the last four years, federations for sports like cycling, speed skating, biathlon and cross-country skiing have begun using programs to measure athletes' red blood cells. In cycling, for instance, those athletes who have a hematocrit, or percentage of red blood cells in whole blood, above 50 percent, are suspended for two weeks. Seven riders have been caught this year and about a dozen last year. These programs are not referred to as doping tests but as health-protection initiatives. Those caught are not branded as cheaters or banned for long periods. Controversy has erupted on sevemI fronts. In speed skating, for instance, the tests have been voluntary instead of mandatory. Doctors in Italy and Norway are working on tests that would detect synthetic use of EPO. Last January Dr. Francesco Conconi of Ferrara, Italy, reported that encouraging steps had been made in isolating synthetic EPO from naturally occurring EPO in urine samples. However, research on a reliable test for EPO lags behind research to detect synthetic human growth hormone, another banned substance used by athletes for its steroid-like qualities. SAMARANCH WOULD SLASH LIST The list of banned doping products must be slashed, and substances that do not damage an athlete's health should not be prohibited, Juan Antonio Samaranch, the head of the International Olympic Committee, said Sunday, The Associated Press reported from Madrid. Speaking about the scandal involving the Tour de France, Mr. Samaranch told El Mundo that he has been asking for an "exact definition" of doping "for years." "Doping is everything that, firstly, is harmful to an athlete's health and, secondly, artificially augments his performance," Mr. Samaranch said. "If it's just the second case, for me that's notdoping," he said. "If it's the -first case, it is." - ---