Although a handful of academics like Bernat López have challenged the empirical flimsiness of the death and health danger claims underpinning anti-doping policy, the press generally has not. An honest examination of the true risks of doping would be harmful to both the business of anti-doping and the business of sports media. As López wrote in a 2011 paper on the EPO death fable, “Examining the mythical nature of these stories is bad news for the anti-doping campaign, because athletes, policy-makers, media and public opinion would be less convinced by the health-risk arguments if the history of doping were short of victims.”1
And victims make good copy. Take track star Florence Griffith Joyner, who died in 1998 after suffering a seizure caused by a blood vessel abnormality called cavernous angioma. The five-time Olympic medalist and two-time world-record holder’s autopsy found Tylenol and the antihistamine Benadryl in her system. While the medical report conclusively pointed to suffocation due to a seizure as the cause of death, posthumous media coverage floated the notion that her death was related to doping.
Because doping in sports does not kill many people, at times the media shows its frustration with the lack of bodies. In 1998, the New York Times publicly wished that Griffith Joyner’s death would be linked to doping. In a September 26, 1998, article, writer Ian Thomsen complained, “For decades now we have been hearing from the medical experts that steroids and other performance-enhancers are destructive. But the warnings have lacked the hardest evidence. The doctors have claimed that these drugs can cause death—but who of any great fame or impact has died as a result?”2
Doping stories electrified the headlines in 1998: from the Festina affair to baseball player Mark McGwire’s locker-room stash of androstenedione, to the criminal trials of East German sports officials. Events seemed to come so fast and thick that performance-enhancing-drug use was apparently a full-blown public health crisis. And yet, no bodies. Thomsen, whose day job was senior writer at Sports Illustrated, mentioned the EPO–cyclist death claim as evidence that doping might be deadly. In the New York Times, he wrote, “The willingness to risk everything seems to be borne out by many of the professional cyclists who reportedly use the blood-thickening drug EPO even though the deaths of several colleagues have been linked to that very drug.”
To be sure, Thomsen equipped his EPO-kills anecdote with two conditional escape hatches—“seems to be” and “reportedly.” While EPO-kills anecdotes might serve a crusader’s anti-doping project, at some level, Thomsen knew without the word “EPO” on an autopsy, society’s moral outrage was built on a bogus causality between the new blood drug and death. Still in pursuit of proof that might help his cause, Thomsen wrote of Griffith Joyner, “If it could be proved that she used those drugs to win three Olympic gold medals and set two world records in 1988, her name would become a rallying cry for those who believe that the purest of all of mankind’s sports has itself been poisoned by the use of those drugs.” That is, if only we could prove that Griffith Joyner died from the stuff that everyone says is killing athletes, her death would become the milestone at which sports turned back and returned to a state of sporting Eden.
Two months after the Festina affair showed how little progress anti-doping missionaries had made in reforming the ways of the natives in their pro cycling habitat, the New York Times needed a body, an incarnation, to show that all the dope-kills fuss amounted to something, that it was not a foolish errand. “If it turned out that Griffith Joyner was in fact poisoned by drugs that she took a decade ago,” Thomsen wrote, “then she, a tragic figure at the age of 38, would become the embodiment of the most important, and currently the most futile, cause in her sport.”
Once doping can be proven to kill athletes, it becomes a huge story. And yet, lacking hard evidence that any athletes were using drugs to push their bodies into the grave, the story Thomsen was aching to write did not exist.
Following sports gives us a plot-twisting lift from the predictability of daily life. Watching heroes fall is part of that entertainment product. From Barry Bonds to Marion Jones to Lance Armstrong, there is a staring-at-the-car-wreck fascination with watching people far more talented than we fall from grace; they aren’t so superior, after all. And when physical harm and death are added to the tragedy, a compellingly sinister element joins sporting gods crashing to earth.
The press also knows that dread captivates. The story of drugs through the 1950s was one of scientific miracles and social panacea. In the 1960s, however, drugs took on a sinister alter ego. With thalidomide and a parade of addicts returning from Vietnam, pharmaceuticals became a source of tragedy, and the media covered this story. Given a choice, readers will choose to learn about the doping transgressions of a superstar over yet another Tour de France race stage report. As sports historian Verner Møller told me, when it comes to keeping the public’s interest, “Real news is bad news—bad news about somebody or bad news for somebody.”
Møller explained that readers are not interested in a more nuanced understanding of the motives behind doping. “We can’t explain to our audience why they are taking this, and justify why they are taking it because that is academic, and that is not interesting for the public. What is interesting is if we can disgrace a star. If we can take a person who has been celebrated and show that he is a culprit, then we have real news.”
The media has an incentive to keep the doping story simple, to describe it in elementary terms of good and evil, rather than attempt to explain the complex, interdependent variables of mutual complicity that led to—and continue to support—doping in sports. Both the media and anti-doping agencies like WADA gravitate toward the binary narrative because it fills in the sinister storyline that all pro athletes are guilty until proven innocent. “WADA is an organization which needs to talk about health and protection of athletes and say that we are a success because we have come a long way in testing,” Møller said. And as long as the black-and-white doping storyline stays alive, WADA can say, “We need more funding so that we can expand our regime and test the athletes even more.”
Running full speed with the EPO-kills story certainly made sense for the press. As sociologist David Altheide explained in his 2002 book Creating Fear: News and the Construction of Crisis, we like stories that transport us beyond the ordinariness of our everyday lives. Narratives that take us “outside the boundaries of routine behavior” are fascinating.3 So much so that, like the EPO-kills-cyclists story, if repeated often enough, we suspend disbelief and begin to accept the story at face value. For instance, when surveyed in the late 1990s, Americans consistently said crime was among the nation’s most serious problems. In fact, by 1998, the national murder rate had fallen 20 percent since 1990; the country had never been safer. However, over the same time span, television coverage of murders had risen 600 percent. Americans’ spiking fear was not a response to firsthand experience with actual crime but a dread manufactured by exposure to the media’s distorted representation of isolated incidents. While dropping crime rates indicated that life in America should have been cause for less anxiety, the projection of a 24-hour murder reel into every living room in the nation made it feel like danger lurked outside every suburban front door and in every city park.
Television news turned a shrinking hill of crime into a scary mountain because that was what kept viewers tuned in. Surveys and TV ratings show that people are more likely to tune in to sensational news about humans acting in deviant, criminal ways than stories about people behaving predictably.4 This phenomenon creates a feedback loop where our fears are continuously fed by a heavily distorted view of life that in itself is powerfully intoxicating.5 As a result, the daily news does not reflect reality, but instead constructs a version of truth that satisfies readers’ interests and curiosities—and keeps them glued to the TV and telling their friends about what they have seen. The news product was crafted to keep viewers around in the increasingly crowded cable and Internet universe, not to reflect the relative mundanity of life in First World America. Call it manipulative or call it business, during the 1990s—the same period when today’s anti-doping agencies became established—reporting in the mass media, both in the United States and abroad, shifted from delivering the facts to focusing public interest on deviant or violent happenings.6
“Many of these narratives about crime and fear are believable because they ‘sound and look right,’” Altheide wrote. “But they are really false, simply incorrect, often created and distorted by news sources . . . and numerous ‘reform’ and ‘social movement’ groups.”7
Anti-doping organizations and their representatives are one such group that has society’s moral hygiene and its own self-promotion in mind. Anti-doping agencies and anti-doping researchers distorted the purportedly deadly dangers of EPO to fit their social reform needs. True to Altheide’s theory, the media picked up on the “official” EPO-kills version of reality and repeated it so often that soon the public agreed that “everyone knows” EPO is deadly to bike racers.
Anti-doping organizations also used this evangelism of fear in an effort to deliver athletes to a state of drug-free salvation.8 The alternative to riding clean was death in a bed at the age of 20. Even though there were no certified EPO deaths on hand, by repeating the rumor over and over, the media, anti-doping agents, and even medical scientists manufactured a sense of fear that in turn justified the creation of dramatically more aggressive forms of athlete surveillance, testing, control, and punishment.
Altheide also explains that a fear-driven media story divides society into three categories of actors: predator wolves, virtuous sheep, and crime-fighting sheepdogs; criminals, innocents, and cops, in other words.9 As EPO stories began to make headlines in the 1990s, the sports world fell into these types. Drug-dealing doctors like Ferrari and the athletes he served were wolves preying on nondoping competitors and young athletes who emulated their chemical ways. Robbed of “fair” racing, the public and some journalists were also victims. “What chance had I against guys riding on amphetamine?” asked Paul Kimmage, a pro rider turned writer, in his 1990 book A Rough Ride. “I couldn’t understand how they could be happy winning, knowing they had taken a stimulant to do so.”10 The title of Juliet Macur’s 2014 book on Lance Armstrong, Cycle of Lies, captures the sense of moral aggrievement simmering beneath the New York Times journalist’s account of a rider who had lied to her face for more than a decade.11 Other writers were sheepdogs, anti-doping agents trying to keep the doping wolves away from the innocent sheep by doing the investigative work that financially conflicted sports governing bodies would not. The Irish journalist David Walsh made an award-winning career writing investigative books and articles that tore at the protective shield Armstrong built with his cancer-survivor history.
Anti-doping regulators and politicians had long tried to capitalize on this three-actor drama, wheeling themselves up to podiums in the wake of every drug scandal in an effort to pass themselves off as good cops out to maintain peace in the kingdom of fair play. A year after EPO was approved for use in Europe, IOC president Samaranch put a figurative sheriff’s hat on his head and a missionary’s staff in his hand for the 1988 Seoul Olympics. In his opening remarks, he proselytized, “Doping equals death.”12 When Canadian sprinter Ben Johnson tested positive two weeks later, fellow Canadian and IOC vice president Richard Pound announced that Johnson’s expulsion showed that the IOC sheepdogs were not sleeping but doing the hard work to “turn this around to make the slate clean and show the world that we do mean business.”13
Referring to a fictional tale of death and mayhem caused by EPO, scores of politicians, scientists, journalists, and sports managers promised spiritual and physical salvation while protecting their own power. As López told me, this transition away from reporting straight facts to focusing on stories that sound right or that feed audience entertainment desires was not a matter of the media being wicked or studiously devious. Rather, it was simply the way the media operates in contemporary society. “It’s in their DNA,” López said. Because the media lives and dies by drawing an audience, they have to tread a line between entertaining and informing. “It’s their way of being, they cannot avoid doing that,” López explained. “And they will always do that with stories. They will select and give prominence to those stories that tap in to the sensational, the morbid, stories about excess, about death, about drama.”
Death by drugs fits the bill. Death by heatstroke or a genetic heart defect does not. The first is a human choice, an indicator of unchecked desire. The latter are mundane circumstances of everyday life. And so in the public’s and the media’s minds, drugs have become the biggest threat to athlete safety, even though the American College of Sports Medicine (ACSM) shows that heatstroke, heart failure, and head injuries are the most common causes of death among athletes. There are too few deaths related to performance-enhancing drugs—essentially none—for them to make the list of top athlete killers. Death from doping does not warrant a single mention in the ACSM-sponsored publication Preventing Sudden Death in Sport and Physical Activity.14
Although only one pro cycling death has been conclusively linked to doping—Tom Simpson at the Tour de France in 1967—death by other means is quite common in sports. According to the U.S. National Highway Traffic Safety Administration, in 2013, 743 cyclists were killed on American roads.15 Playing American football is also a good way to shorten life. Statistics collected by the National Center for Catastrophic Sport Injury Research show that between 1931 and 2015, 1,046 athletes died playing recreational, high school, college, and pro football. Seventeen were killed during the 2015 season; three of those were cardiac failures that took place off the field. ESPN reported that during August and September 2014, more than a dozen football players died from sudden cardiac arrest. Three high school players died during a single week in the fall of 2014, one while warming up and two from injuries related to tackling impacts.16 In 1968 alone, 36 football players died from head and neck injuries—26 in high school, 5 in college, 4 in recreational play, and 1 in the NFL. Between 1995 and 2015, 59 football players died from heat stroke. Unlike Knud Enemark Jensen, their deaths were not blamed on amphetamines.17
While EPO caused only mythical deaths, American football is a killer of record. The sport’s overseers have finally become concerned about the long-term effects of repeated head trauma, and high schools now limit the number of hours players can practice in summer heat. However, no global enforcement agency has been established to fight the scourge of football deaths. Compared to its uproar at the fabricated deaths of 18 or so cyclists, the press’s relative silence about the very real deaths of hundreds of football players suggests that when drugs are involved, the story taps into a deep wellspring of shared human anxieties that does not exist with real killers like heatstroke, sudden cardiac death, and concussions.
Popular magazines spread the EPO myth to a circle of influence far beyond cycling fans. In some cases, these magazines even used otherwise well-respected scientists who, perhaps blinded by superimposed moral judgments regarding the wrongness of doping in sports, helped spread misinformation and fanned an increase in anti-doping hysteria.
The April 2008 issue of Scientific American provides an example. In a thought-provoking article on game theory and doping in sports, science historian and skeptical thinker Michael Shermer retold the story of how French rider Philippe Casado stopped riding with Greg LeMond’s GAN team in 1993 because the squad had no organized doping program. Casado moved to an Italian team that ostensibly supported his pharmaceutical needs. Not long after making the move, the Frenchman died of a heart attack while playing rugby. Commenting on Casado’s demise, Shermer wrote:
Whether his death resulted directly from doping is not known, but when HCT reaches around 60 percent and higher, the blood becomes so thick that clots readily form. The danger is particularly high when the heart rate slows during sleep—and the resting heart rates of endurance athletes are renowned for measuring in the low 30s (in beats per minute). Two champion Dutch riders died of heart attacks after experimenting with r-EPO. Some riders reportedly began sleeping with a heart-rate monitor hooked to an alarm that would sound when their pulse dropped too low.18
The Casado story was repeated elsewhere in the press. In November 2007, CyclingNews.com reported on a doping panel discussion in Chicago in which LeMond described dropping out of the 1994 Tour de France. LeMond pointed out that seven months later, Casado was dead of a heart attack—implying that the Frenchman’s death on a rugby pitch was related to doping on the bike.19 Sportswriter Bill Gifford retold the same LeMond recollection in a 2008 Men’s Journal piece.20
But while CyclingNews.com and Men’s Journal simply recounted LeMond’s memories of Casado’s death (and in so doing further entrenched the speculation that it was related to performance-enhancing drugs), Shermer reported the unproven allegations about Casado’s death as fact. It was the case of an esteemed science writer and a self-defined skeptic reinforcing a central myth of the anti-doping movement rather than investigating it.
Shermer, a prolific author, science television host, and veteran cyclist who rode in the Race Across America, is also executive director of the Skeptics Society, a nonprofit dedicated to investigating “fringe science, pseudoscience, and extraordinary claims of all kinds.” Yet his Scientific American piece reasserted the extraordinary, but empirically groundless claim that EPO killed cyclists. So powerful was the EPO-kills myth that a philosopher of science with Shermer’s intellectual chops repeated every one of its sketchy sustaining details without running it through his own filter. And the myth lives on. The notion that EPO is at the root of a glut of cycling deaths got its own performance-enhancing boost when Scientific American republished Shermer’s story in a 2013 book, Doing the Right Thing: Ethics in Science.
When it comes to propping up the EPO-kills shibboleth, both journalists and anti-doping campaigners get an assist from retired pro riders. After removing their last race number, some pros romanticize their own pasts. Whether the rider retired in 1950, 1960, 1970, or 1990, his glory days become representative of a morally and physically pure era before cycling was ruined by drugs. This nostalgia for days before sports had fallen helps feed the erroneous public conception of doping as a relatively new problem and the past as a time of water-fueled fair play.
Bernat López studied this phenomenon. In a 2014 paper he revealed how 1930s and 1940s Italian superstar Gino Bartali argued that after he retired, a new brand of doping changed cycling for the worse. Even though Bartali was quick to adopt the suppository aids popular with his archrival Fausto Coppi when he was racing, in his retirement years, Bartali—a three-time Giro winner and double Tour de France victor—alleged that the new 1950s drugs were destroying the sport. Commenting on a 1959 Tour de France time trial, Bartali muttered, “It is impossible to ride at an average speed of 48 kilometers per hour on a parcours of 45 kilometers without having drunk from the ‘little bottle.’” He then added that contemporary drugs were turning donkeys into racehorses: “It is impossible to reach this average speed without anti-natural means. If I were still a rider, I would have lost four to five minutes today.”21
In 1980, 1973 Tour de France winner Luis Ocaña pointed out that during his racing days, amphetamines were not as dangerous as corticosteroids, which riders injected to mask pain and reduce swelling from problems like knee injuries. “Taking amphetamines was ten times better, one thousand times better, it was infinitely less dangerous. Abusing cortisone is serious, very serious,” the Spaniard warned. Ocaña’s French contemporary Roger Pingeon fretted that the drugs riders were taking in the early 1980s were “far more dangerous” than the drugs used when he was a pro in the 1970s.22
Of course, 1980s pros felt their era was pristine compared to the 1990s. In his autobiography, We Were Young and Carefree, 1983 and 1984 Tour de France winner Laurent Fignon downplayed 1980s doping. “Everyone was behaving in the same way, more or less, and using the same drugs,” the French rider recalled. “Until about 1989, drug-taking in cycling was an unsophisticated affair.”23 The doping Fignon participated in was steeped in a freshening nostalgia. Fignon describes pro cycling in 1984 and 1985 as “a high point, a zenith of beauty. It was the pinnacle on a building that was about to crumble; the last great gasp of a golden age that would not return.”24 Some of the golden light dressing those years may emanate from Fignon’s successes. When he won the 1983 Tour de France, Fignon was only 23 and it was his first attempt at the race. Fignon explained that his was an unsullied, dignified era because drugs were not transformative. “Back then there was no drug, whatever it might have been, that could turn a donkey into a thoroughbred.” After 1993, Fignon claimed, “Nothing was the same again.”25
The magic donkey. Retired riders are fond of trotting out the metaphor of the burro pharmaceutically transformed into Secretariat. For every retired generation, contemporary drugs are more physiologically effective, technologically advanced, and morally corrupting than the chemicals from their racing days. Nostalgia can sanitize history, and the past is a cudgel riders use to beat down a corrupt present. Recalling his abandonment of the two-day Critérium International race in 1990, Fignon wrote, “I got off my bike. I just quit. I no longer saw any place for me among colleagues with a code of conduct in which honor and sacrifice were old-fashioned eccentricities.”26 In other words, not only had the new drug EPO given the peloton another set of gears, but in Fignon’s mind, this drug represented the onset of a new moral decay. “From Coppi to Hinault, passing through the eras of Anquetil and Merckx, there was no magic that could dose up lesser riders to compete on equal terms with the greats,” he bemoaned. “Exceptional human beings, like their extraordinary exploits, were authentic.”27
Greg LeMond beat Fignon by eight seconds in the 1989 Tour. When I spoke to the American about the arrival of EPO, he echoed Fignon’s sense of bewilderment and betrayal. “The EPO era just popped up and confused everybody,” LeMond recalled. Thanks to speculative press stories, the synthetic hormone also scared him. “I had a teammate that died,” LeMond said, referring to Casado’s January 1995 death. LeMond was not alone in pointing to EPO as the culprit. Although no hard evidence of a link exists, when Casado passed away at age 30, journalists and riders alike jumped to the conclusion that his heart attack was associated with the blood hormone. “It was a slow growth. You heard rumors about it, but then you had a bunch of deaths,” LeMond recollected. “I remember on the French teams, that really got to people—like, ‘whoa, this is crazy.’”
Once retired, LeMond and Fignon’s former manager Cyrille Guimard also transformed from a pragmatic coach who saw doping as a tool of the trade to an anti-doping campaigner. Guimard raced in the 1960s and 1970s, and in his autobiography, he explained that amphetamines were a “main course” in the pro cyclist’s race-day diet. He went on to call the doping of his era “quite trifling,” “minimal,” “nothing serious,” and, prior to the 1980s, “do-it-yourself.” In a 2012 interview with French newspaper L’Humanité, he argued that 21st-century doping is “light years” ahead of where it was in his day. With doping, “there is an enormous difference between yesterday and today,” he claimed. While the drugs of his era mainly had a placebo effect, he said, with EPO “everything is different. It augments performance by 5 percent. We are no longer in the same world.”28
During his racing and management years, Guimard scorned journalists who tried to hold him accountable for doping, calling them “sanctimonious minds” who made him feel like the subject of a “witch hunt.” After his management career ended in the mid-1990s, Guimard’s lenience toward doping changed. Suddenly a minister of purity, Guimard advocated adopting a rule that would force pro cyclists to forfeit a year’s salary if caught doping. Describing himself as a “partisan of tightening the rules,” he also agitated for lifetime suspensions for doping cheats.29
When retired Tour de France champions talk, people listen. López suggests that carping from these stars has had a lasting effect on anti-doping policies and enforcement methods. Retired pros often take on roles with national and international sports governing bodies, with the media, with the Olympic movement, or with anti-doping organizations. Louison Bobet became a journalist. Fignon and Guimard worked as commentators. LeMond built a bike company and stayed involved with junior rider development. Anti-doping agencies and national organizing bodies listen to these influential figures when they hold forth on the current state of the sport.
As we have seen, as active racers, riders justified their youthful doping because everyone else did it, and by arguing that dope wasn’t that effective anyhow. López argues that such self-justifications ignore the fact that “‘new’ and ‘old’ substances never shared the same playing field; taking their careers as a whole, those consuming ‘old’ substances raced against other people taking more or less the same products, and the same applies to those using ‘new’ substances.”30 Eliciting a mythic, moral past as an impossible (and fictionalized) ideal that today’s world should follow as a model, these nostalgia-infused retired riders demand radical, if not impossible enforcement crackdowns on the modern moral and chemical scourges corrupting cycling. And this wielding of a mythic “better” past reinforces anti-doping propaganda—such as the rumors that LeMond inadvertently built around the supposed deadliness of EPO.*
López shows that when they raced, the pro riders criticizing cycling today were eager sports medicine innovators. Once they hang up their racing wheels, though, the same riders attempt to slam the brakes on the current generation of working pros when they repeat the cycle and try to find novel advantages with chemicals. The end result, López explains, is that the retired riders “join the ranks of the claims-makers involved in the construction of the social problem of doping” and push the further radicalization of anti-doping policies and enforcement mechanisms.”31 When journalists profile the retired rider whining about how much cleaner cycling used to be, it reinforces the notion that the sport has fallen into a state of ethical perdition that can only be saved by draconian regulations and punishments.
Scientists working in the anti-doping field are influenced by sensationalistic EPO press coverage as well as the opinions of nostalgic retired stars. These layperson opinions affect academic conclusions in surprising ways. Lacking any corpses surrounded by Epogen cartons or clinically sound autopsies to support a link between EPO use and death, a remarkable number of academic researchers cite articles in the popular press as evidence of the lethality of performance-enhancing drugs. The popular press references are often flat-out wrong. And yet, once a reference to EPO-caused death appears in an academic journal, this “proof” is sanctified by the aura of peer review. It is then repeated over and over in other academic citations. What starts in the popular press as an interesting and lusciously fear-confirming rumor about a drug killing young, elite athletes is run through an alembic of scientific citations. What comes out of the beaker is a nugget of bogus, but apparently empirically validated, “fact.”
Take the 2007 book Blood Sports: The Inside Dope on Drugs in Sport. Written by respected Australian doping researcher Robin Parisotto, Blood Sports claims that EPO “has caused more deaths than all the steroids and stimulants ever used.” To support this bold claim, Parisotto writes, “Between 1987 and 1990, 18 cyclists died tragically and suddenly and all from heart attack or stroke. EPO was known to thicken the blood—the common cause of heart attack or stroke. Many victims developed clots that broke off and travelled to their hearts or brains; others died of heart failure, the organ struggling to pump blood the consistency of oil. That EPO was at least in part responsible seemed obvious, but sporting authorities at this stage showed little interest.”32
Parisotto’s phrasing suggests that sporting authorities were not interested in the EPO-death connection because they were not serious about clamping down on doping. While this may be the case, it is also true that the “obvious” connection between EPO and the athletes’ sudden deaths was speculation—a jump to conclusions based as much on growing hysteria over doping dangers as the inspection of postmortem studies.
Today Parisotto works as a stem cell scientist in Australia. He also consults on anti-doping protocols and procedures with organizations including the Australian Institute of Sport, WADA, and Russia’s anti-doping federation. I called him to ask about the discrepancy between his claims that EPO tops the list of lethal drugs and research showing that EPO hasn’t been tied to any athlete deaths.
I had sent López’s paper on the myth of EPO as weapon of mass destruction to Parisotto ahead of our call. He complimented the thoroughness of López’s research and was not defensive about the challenges it presented to his own conclusions. Parisotto told me that one problem with drawing inferences about the adverse effects of drugs on athletes is that it is difficult to run clinical trials. “In the medical world, you can’t conduct an ethical trial on the basis that you might actually kill the patients,” Parisotto explained. Clinical trials work the other way; you take a population of afflicted people, give them a drug or placebo, and then monitor which patients get better as a result of the drug. If it turns out that the drug has an unacceptable number of deadly side effects, then it does not get approved. Taking a sample of healthy people and giving them drugs with the intent of making them sick or killing them violates medical ethics. While this sort of testing happened in Nazi Germany and even in the GDR sporting system, contemporary medicine does not allow it today—at least not in democratic nations.
When drawing his conclusions about the link between EPO use and the dying cyclists, Parisotto told me that clinical trial limitations make conjecture inevitable. Doping policy laws are always going to be based on clinically unverifiable assumptions about both harmful and performance-enhancing effects of drugs. Speaking of the rider adoption of EPO in the late ’80s and early ’90s, Parisotto pointed out that “the ethos at the time was that if a little bit works, then more must be better. And I suspect that in those early days, the athletes were using very high dosages of EPO. And because of that, I suspect there was a link between the uncontrolled use of EPO and those deaths.” Based on the way weight lifters went crazy with anabolic steroids after John Ziegler introduced Dianabol to sports in the 1950s, Parisotto’s inference makes sense.
Parisotto admitted that his conclusions about the deaths of 18 Dutch and Belgian cyclists were deductions made without any observed evidence. Based on what science knew about EPO’s capacity to thicken blood, and elite athletes’ well-documented habit of taking heavy drug loads for an equally meaty performance enhancement, the doping researcher felt the conjecture was warranted because it would save lives. “You can never actually prove” EPO caused the deaths, Parisotto said. But the apparent correlation seemed too uncanny to ignore. “Jeez, it was pretty strong anecdotal evidence that something is amiss,” Parisotto exclaimed.
I proposed to Parisotto that both the press and academic researchers took it at face value that EPO killed cyclists because the connection sounded right and because it furthered the anti-doping cause. He confessed that yes, the press reports and books like Blood Sports played a propaganda role; they were meant to raise public awareness of doping dangers. “I must admit that the reports of the deaths in the media were an impetus for the public to become informed and for the anti-doping organizations to get off their tails and actually do something about it,” he told me.
For some, the hype seemed to work—as LeMond told me, early 1990s media coverage of EPO deaths made him step back and think, “Whoa, this is crazy.” And while it’s difficult to link an absence of deaths to any media campaign, the fact that no rider has ever conclusively died from EPO might indicate that books like Parisotto’s did scare athletes into either not using EPO or into making sure they used it with medical supervision.
As for López’s research suggesting the press and the anti-doping community constructed a fearful, fictional narrative about a drug of mass destruction because it furthered a quasi-religious ethical hygiene project, Parisotto thinks it is a reasonable claim. However, he also can’t remember “anyone consciously constructing an argument, and I certainly don’t recall any of the sporting organizations constructing an argument, that we must do this. If anything, a lot of the sporting organizations were reluctant to do anything about it.”
Parisotto wasn’t the only scientist from the Southern Hemisphere who let a sense of obligation to the anti-doping cause affect the accuracy of his conclusions. WADA board member and New Zealand University of Otago professor of sports medicine Dr. David Gerrard wrote in a 2008 journal article titled “Playing Foreign Policy Games: States, Drugs and Other Olympian Vices” that EPO caused “formerly fit young athletes” to drop dead “from massive strokes and heart attacks.” An ex-Olympic swimmer, Gerrard noted that “post-mortem studies revealed the extent of the damage.”33 And yet, no postmortem study exists that shows a link between EPO and the death of an athlete. The reference Gerrard refers to as the source for his EPO-autopsy claim is a chapter on drugs in sport in a popular Australian sports medicine textbook, Clinical Sports Medicine.
Found in the offices of some 20,000 clinicians around the world, a chapter on drugs and sport by Liz Clisby states that EPO use “has allegedly become widespread and may have contributed to the death of a number of European cyclists.”34 Nowhere does Clisby’s chapter mention the postmortem studies Gerrard cites as proof for his claim. Following the footnote trail confirms how the EPO-kills notion can start as reported rumor, then quickly ossify into fact through word choice when one clinical or scientific reference cites another. Elsewhere in the same chapter, Clisby takes a more assertive stance, writing, “There have been a number of deaths of endurance cyclists directly related to the use of EPO.”35 The footnoted source for this claim is an August 1989 article in the American medical journal the Physician and Sportsmedicine. With this citation, it seems we may be getting closer to the source of this winding tributary of allegations and suppositions.
Titled “Erythropoietin: A Dangerous New Form of Blood Doping,” the piece by Virginia S. Cowart explains that EPO was approved by the FDA earlier in 1989 and cites the opinion of former USOC medical director Robert Voy. Warning athletes away from the synthetic hormone, Voy cautions, “If it overshoots what is physiologically tolerable for the cardiovascular and pulmonary system, some athletes will develop heart failure and pulmonary edema. We may even see deaths.”36 Voy’s warning was reasonable—taken without doctor’s supervision, EPO could kill. Also, the drug was so new that there were little clinical data upon which the doctors could base their recommendations. Advising extreme caution when using this new hormone made physiological and ethical sense. In the Physician and Sportsmedicine article, Voy did not state that EPO had killed anyone. However, in his 1991 book, Drugs, Sport, and Politics, he describes “an alarming rise in the number of deaths among European cyclists who use erythropoietin.” Voy also writes, “I’m sure it won’t be long before a high-profile American athlete kills himself or herself using this hormone.”37
Warning that increased hematocrit levels combined with lower blood volume due to dehydration might cause stroke or heart-attack-inducing “sludging red cells,” Cowart’s piece also tells readers that the drug’s administration method increases its potential for harm.38 HIV/AIDS had been killing and harming people for years in 1989, so caution with injections was warranted. EPO may be especially dangerous because unlike autologous blood doping, which requires a doctor’s assistance, athletes can easily self-administer EPO. Later on in the article, 1984 Los Angeles Olympic drug-testing lab director Don Catlin explains that “erythropoietin can be injected in the privacy of one’s home—and nobody else has to know about it.”39 Catlin also mentions EPO’s potentially dangerous dose-response curve; because the effects of EPO can cause hematocrit to continue to rise for up to 10 days after the last injection, the dangers can lurk—and even increase—over time. “The danger doesn’t end when the race ends,” Cowart warns.40
Although the Physician and Sportsmedicine article toured EPO’s dangerous side effects, nowhere did it cite a single death, let alone the “number of deaths” confidently referenced in the Australian sports medicine textbook. In fact, the article cited Michael Downing, Amgen’s director of clinical studies, who gave a fairly neutral assessment of EPO risks, saying, “It’s difficult to say with certainty what kind of effect erythropoietin would have on persons with healthy kidneys.”
If they were not reading the Physician and Sportsmedicine piece carefully, however, the Clinical Sports Medicine writers might be excused for making their evidence-free leap from plausible harm to dead bodies. The article grabbed readers’ attention with an illustration of a giant blood cell crushing a cyclist sprawled on a forbidding forest road. Like a bloody knife in a murder scene, a syringe lies on the ground in front of the rider’s shattered wheel. The gargantuan erythrocyte seems to have sprung from the woods in deadly ambush. Behind the cyclist, a single-lane road wends across hills toward a chasing pack of cyclists racing away from a setting moon. A propagandistic film-noir scene, the illustration fused fear, crisis, crime, social disruption, and sports competition into a powerful promotion of the article it illustrated.
“Fear is a social product and not an individual failing,” Altheide explains in Creating Fear. “Fear is a manufactured response that has been produced by a mass-mediated symbol machine.”41 Here, at the dawn of the EPO era, the medical community painted a picture of doping as a social dynamic between law-abiding victims, doping athletes whose own lawless ambitions ended up murdering them, and a medical community whose good inventions helped enable this dramatic morality tale.
Despite the ease with which academics cited erroneous sources as proof that EPO kills cyclists, some doctors did question why so many were so quick to make such an erroneous leap of faith. In August 1998, the British medical journal the Lancet published a study, “Packed-Cell Volume in Elite Athletes,” by researchers J. J. M. Marx and P. C. J. Vergouwen. The Dutch scientists tracked the hematocrit levels of 18 male and 28 female Olympic-level athletes over 16 months. To the best of the researchers’ knowledge, these athletes were not taking EPO. The scientists found that six of the subjects had naturally occurring hematocrit levels above 50 percent. They also found that some athletes had hematocrit levels as low as 34 percent. Marx and Vergouwen concluded, “Although everything possible should be done to protect athletes against any kind of doping that may be harmful and that may falsify competition, in the case of EPO the IOC and UCI might consider whether taking a nondetectable substance that is able to correct a physiological inequality among competitors should be considered as doping.”42
In other words, the researchers wondered if athletes handicapped by naturally low hemoglobin counts should be considered dopers for turning to a blood therapy that would create a level physiological playing field. With little evidence that EPO is unsafe when administered under a doctor’s supervision, they suggested that EPO could fulfill the fair-play objective central to the anti-doping movement. The authors also pondered whether it was fair to punish athletes with naturally high hemoglobin counts for doping when their red-blood-cell tally was solely a natural phenomenon.
POINTING OUT THAT warnings against the dangers of EPO are founded on a fiction about a glut of cyclist deaths is not an argument for its removal from WADA’s list of banned substances. As Michele Ferrari observed, EPO is dangerous when abused. In 2007, the FDA underscored EPO’s riskiness when it issued a black box warning for the product, which came about in part because Amgen learned that EPO could accelerate cancer tumor growth. However, this warning was intended for the seriously ill and came 17 years after sports journalists and anti-doping scientists had started screaming that the sky was falling without a single body to prove it.
By focusing on the fear surrounding doping in sports, medical experts channeled significant resources toward a health problem that was almost totally insignificant when compared to other causes of death that are intrinsic to sport such as tackling in football or head injuries in cycling. The sport’s administrators at the UCI began the march toward drug prohibition in 1965, yet cyclists died from head injuries for another 38 years until the UCI took steps to slow the carnage by making helmets mandatory for racing in 2003. Emotion, not logic, controlled the sport’s response to the risks threatening its athletes.
Writing in the science journal Nature, in 2008, researchers Björn Knollmann and Dan Roden reported that sudden cardiac death kills between 500,000 and 1 million Americans and Europeans every year—10 to 20 percent of all deaths in the western world.43 A study of sudden cardiac deaths in Maastricht, Netherlands, between 1991 and 1994 found that of the 2,030 deaths that occurred outside hospitals during that time period, 375 were sudden. In one Dutch city of nearly 200,000 bike-riding people, sudden death killed 94 residents every year. At exactly the same time, European newspapers were blaming EPO for the sudden death of 18 cyclists worldwide. For 53 percent of the women and 44 percent of the men who died in Maastricht, their sudden cardiac arrest was the first indication of a heart problem. That is, like the pro cyclists who died “from EPO,” the 94 sudden deaths in Maastricht came out of the blue. And yet, because the citizens of this Dutch city were not pro cyclists, the apparent glut of sudden deaths was not attributed to EPO, but rather to genetics.
Another study published in the European Journal of Cardiovascular Prevention and Rehabilitation in 2006 provided a meta-analysis of 47 scientific papers on sudden death in athletes under 35. The articles covered 1,101 cases of sudden cardiac death in athletes. (Sudden cardiac death is defined as a death within one hour of onset of symptoms, and in a person with no previously identified cardiac condition.) The report concluded that 60 percent of the affected athletes had genetically inherited heart issues or early onset atherosclerotic heart disease. Intense physical workouts triggered the catastrophic heart incidents. With evidence fingering genetics plus extreme exercise as the killer, the researchers exculpated the drug demon: “Doping is often considered to be the main cause of sudden death by the media and lay people,” they noted. But this link “seems unlikely, as underlying cardiac diseases account for approximately 90 percent of exercise-related sudden deaths.” The popular idea that drugs are the most dangerous risk to athlete health is false, they said, and “contradicted by the large numbers of sudden deaths related to underlying cardiovascular diseases.”44
Bad genetics and sports themselves seem to be the biggest factors in athlete deaths. Yet these causes did not serve the purposes of anti-doping organizations, so that is not the story that got written in the popular or scientific press.
López does not harbor ill will toward the scientists and journalists whose selective review of events in the 1990s turned EPO into a killer demon. At a time when EPO had just hit the market, it was a no-brainer to make it suspect number one in what seemed like a sudden rash of deaths. It was easy to jump to the conclusion that if cyclists started dropping shortly after the availability of this new blood-thickening potion, the drug had something to do with it.
As for the goals of the anti-doping campaigners who turned speculation into “truth,” López writes that at some level, they “had the best intentions at heart.” Repeating EPO death tales that had hardened into fact after years of repetition in popular and academic publications was in the interest of saving bodies, souls, and cycling’s reputation.45 In the 1990s, Coubertin’s quest for amateur and social purity had been transformed into an expedition for chemical innocence.
These attempts to eliminate a cheating mechanism, however, only served to advertise it further and bestow it with magically transformative powers, quickly making EPO a must-have tool in the modern pro cycling peloton. The good intentions that glossed over the facts in the interest of protecting Coubertinian notions of sports as a builder of character and a shield against moral decline ended up exposing the wonders of EPO to a wider audience of potential customers.
As University of Geneva exercise physiology professor Bengt Kayser discussed in a 2009 research paper, drug hysterias whipped up by the press and the anti-doping community sent a message that doping works. After all, if the drug didn’t work, there would not be a fuss over it. And the outcome of this prohibition and demonization “may have the perverse effect of amplifying,” rather than eliminating the use of performance-enhancing drugs among pro athletes and the general public alike.46
* Anti-doping inherited Coubertin’s sense of religious mission. The idea of pointing to a better, but lost, past as a motivation for moral and physical purity in the present is fundamental to religious ministries: Eden is lost. We should aspire to return. And yet, elite sports are uncompromisingly engaged with the present—the spirit of elite sport is the abandonment of all other concerns in the interest of conquering in this world. The pure greediness of the champion’s will to victory is what makes pro and Olympic sports so fascinating; elite sports represent what we all could be if the chocks of social expectation were thrown aside. At the same time, elite sports’ essential this-world selfishness is why the anti-doping mission and its quest for spiritual and physical purity have never sat well with world-class sports. Sports’ profanity and anti-doping’s sacredness are antithetical. Curiously, this tension between the sacred and the profane also made for lively times in Puritan America and may have influenced the United States’ historical reluctance to chemically purify its core sports like baseball and football. For an analysis of how the uneasy marriage of the sacred, the profane, and religious mission helped form the American worldview, see Sacvan Bercovitch, The American Jeremiad (Madison: University of Wisconsin Press, 1978).