Dr John Harty

Bike Pure asked Dr Harty to clarify the unfortunately common, illegal doping abuse of Erythropoietin (EPO).

Bike Pure: What is EPO?

Dr. Harty: EPO is a naturally occurring hormone which the body produces to control the amount of blood cells and hemoglobin present in the body.

BP: You're a renal consultant (Kidney specialist), why do you administer EPO to patients in your care?
Dr: EPO is produced in the kidneys in response to stress factors including oxygen levels, this in turn goes to the bone marrow and 'notifies' the bone marrow to produce additional blood cells.

I use it daily with patients suffering with kidney failure. Their kidneys no longer produce this vital hormone so we have to administer it synthetically to the patient to offset this hormone imbalance and regulate their blood to a normal, healthy level.

BP: When did you first begin to administer EPO?
Dr: It came into clinical practice around 1989, when the U.S. Food and Drug Administration approved the hormone and I first administered it to my patients in 1990. It was pioneered to deal with the problem of anemia or low blood count in patients with kidney failure..

BP: Is it essentially the same product that you began using in 1990 or has it evolved and improved over time?
Dr: Over the last 20 years, scientists have improved and evolved the synthetic nature of the drug. About 10 or 11 years ago 'Aranesp' became available, and in the last few years CERA also came into the market.

EPO, Aranesp and CERA are all the same basic structure of the EPO molecule; they just have variants added in to produce a longer lasting effect. When EPO was first introduced it was required to be injected usually three times a week. When 'Aranesp' came out this was reduced to once a week and a single injection of CERA would maintain a patients hemo level for up to a month.

BP: Are all these EPO derivatives made by the same people?
Dr: There are a number of companies making these syntethic EPOs. They are all modifications of the basic naturally occurring hormone. Initially it was only one company, but now there are many variants and low cost drugs available from countries such as China and Russia.

BP: We have heard of athletes being caught because the manufactures have installed 'indicators' or 'markers' into the drugs to illuminate their use in drug tests and indicate that the hemo level was achieved artificially. Could all manufacturers do this?
Dr: As synthetic drugs like 'Aranesp' and CERA are not identical to the natural hormone, it should alone be traceable.
[BP:'Amgen' provide a marker within its own synthetic EPO-CREA to enable its detection in drug tests]

BP: Are there other drugs available that renal patients utilise, which cheats in sport may be using to gain an unfair advantage?
Dr: The best way to get a response from EPO is to have a lot of Iron in your system to help the body make a lot of red cells, so we found out quite early on in kidney medicine that people would become iron deficient which would blunt the effect of EPO.

So with our patients we give them iron, orally or intravenously. The higher your iron stores are, the better effect the drug will have. So I imagine the dopers would artificially take iron and B12 and any other compounds, which are crucial in the production of blood.

BP: As most of the athletes taking drugs are driven for short-term performance gain. Could you tell us the very real side effects of taking EPO?
Dr: The two main side effects of EPO are clotting (thrombosis) and high blood pressure. Of these the one we worry about daily is thrombosis.

This happens as you administer EPO to the system, the number of red blood cells rise in the blood, and your blood effectively becomes thicker and more viscous, thus creating the conditions where the blood is likely to form clots.

If you add into the mix dehydration and a low heart rate [BP both common in endurance athletes] the blood won't be pumping as fast as it should, then you are at significant risk of it clotting.

The main types of clots we see with EPO patients are not clots in your legs, but heart attacks (thrombosis in the cardio arteries), clots in your lungs, and clots in your brain leading to a stroke. All common when the patient is sleeping therefore a greater chance of the system stagnating.

BP: Are there any drugs of that you know of, or are using which would eventually (or already) filter into the sporting community to be used to gain an advantage?
Dr: Hematite among others. Basically, the principle for all of these drugs is essentially the same; all of the epometric compounds drugs which mimic the action of EPO, raising the number of red cells in your blood, therefore the oxygen carrying capacity of your blood. [BP: thus fuel to the muscles]

Basic EPO was a copy of the naturally occurring hormone, the drugs now have evolved to be vastly more efficient than the naturally occurring hormone by adding certain elements to it. This new generation of proteins like Hematite don't look at all like EPO, and although they don't look like EPO they do exactly the same thing, albeit more effectively.

BP: We have heard of athletes taking additional drugs to counter the side effects of blood clotting.
Dr: Yes Aspirin or Warfarin will thin the blood, the trouble is they only go part of the way to prevent your blood from clotting -when you make your blood like glue or tar they can only do so much. But then you expose yourself to the side effects of those drugs as well, so with the less effective Aspirin, you may bruise a lot, but with Warfarin if you get a dose wrong and cut yourself you could bleed to death.

BP: Could you explain why we hear of athletes using stimulants along with EPO?
Dr: As the new generation of drugs like Hematite are so effective, to get the most benefit, I imagine raising your own heart rate and blood pressure further than naturally occurring with the use of cocaine or amphetamines would have the desired effect, although then giving you a whole new table of risk factors.

BP: What about altitude training to increase ones hemo level, not using drugs but artificially nonetheless?
Dr: Well, if you expose yourself to high altitude training, or sleeping in a regulated Oxygen tent where there is a low oxygen concentration, one of the things in your body which stimulates your bodies own production of EPO is hypoxia, (low Oxygen level) and results in more red blood cells and therefore fuel to the muscles.

Whilst this may seem a 'pure' method of getting an aerobic advantage, the same side effects will result. Training at altitude or the use of the tent could feasibly increase your natural hematocrit levels to 55-60%. The implications of such means a rider will be at just as much of a risk of getting thrombosis and sudden death, as you would be if you were injecting yourself with synthetic EPO.

BP: Many thanks to Dr Harty for his time and knowledge to protect the next generation of champions. It is clear that the effects of taking performance enhancing drugs can give an athlete severe health problems, short and long term.

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