Pubdate: Mon, 27 Jul 1998
Source: International Herald-Tribune
Contact: iht@iht.com
Website: 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."