Last updated on: 5/10/2021 | Author:

Should Blood Doping and Erythropoietin (EPO) Use Be Accepted in Sports?

General Reference (not clearly pro or con)

Elizabeth Quinn, exercise physiologist, in a Mar. 26, 2020 article, “Erythropoietin (EPO) and Blood Doping in Sports,” available at, stated:

“Blood doping refers to any attempt to improve athletic performance by artificially increasing your red blood cell count. Red blood cells are responsible for carrying oxygen molecules throughout the body. The more red blood cells you have, the greater your energy expenditure and the slower you will “burn out” during extreme physical activity.

Methods of blood doping include:
–Transfusions of someone else’s blood
–Re-infusion of one’s own red blood cells
–Administration of enhancement drugs such as EPO

Blood doping is in violation of standards set by the World Anti-Doping Agency (WADA) and is banned in professional sports. Even with rigorous testing among athletes, that hasn’t stopped some from doing it anyway…

EPO has been banned since the early 1990s, but the first tests did not become available until the 2000 Summer Olympics.

Abuse of EPO made world headlines when Floyd Landis, the 2006 Tour de France winner, was stripped of his title after testing positive for doping…

EPO is a naturally occurring hormone that can be synthesized in the lab and injected directly into the skin or bloodstream. In terms of sports performance, it has been shown to increase the proliferation of red blood cells and increase the amount of oxygen carried to muscles.

Increased availability of oxygen is believed to slow the progression of muscle fatigue and increased endurance during performance athletic events…

EPO has been shown to induce hypertension (high blood pressure) by literally crowding plasma with excessive red blood cells. This serves to ‘thicken’ the blood, increasing vascular constriction and the overall blood pressure. Greater blood viscosity puts a strain on the heart, increasing the risk of blood clots, heart attacks, and stroke.”

Mar. 26, 2020

The Mayo Clinic, in a Dec. 4, 2020 article, “Performance-Enhancing Drugs: Know the Risks,” available at, stated:

“Erythropoietin [EPO] is a type of hormone used to treat anemia in people with severe kidney disease. It increases production of red blood cells and hemoglobin — the protein that carries oxygen to your body’s organs.

Taking erythropoietin improves the movement of oxygen to the muscles. Epoetin, a synthetic form of erythropoietin, is commonly used by endurance athletes…

Erythropoietin use among competitive cyclists was common in the 1990s and allegedly contributed to at least 18 deaths. Inappropriate use of erythropoietin may increase the risk of stroke, heart attack and blockage in an artery in the lung (pulmonary embolism).”

Dec. 4, 2020

PRO (yes)


Alex Pearlman, journalist and bioethicist, in a Mar. 11, 2021 article, “The Case for More Doping in the Olympics,” available at, stated:

“No scandal garners more attention and more cries of unfairness in sports than pharmacological doping. When bicyclist Lance Armstrong publicly admitted his long history of using hormones like erythropoietin (EPO) to enhance his racing performances around the turn of the century, he became the poster child for sports scandals. But his case was just the tip of the iceberg. When he won the Tour de France for the final time in 2005, he capped off a decade of increasing drug use wherein the vast majority of top competitive cyclists were doping to the point that it would be impossible to compete without ‘the juice.; Doping didn’t create an uneven playing field. It was the playing field…

Isn’t it more honest, if athletes across the board are using techno-scientific doping, to just let them do it? The interwoven prevailing narratives of elite human ability and competitive fairness are falsehoods. To get to the heart of the true ‘spirit of sport,’ we should refocus competitive events to highlight technologies over bodies.”

Mar. 11, 2021


Bode Miller, professional alpine skier and five-time Olympic medalist, in an Oct. 16, 2005 Times Online article titled “War On Drugs Must Continue,” was quoted as having said the following:

“I’m surprised [EPO is] illegal, because in our sport, it would be pretty minimal health risks, and it would actually make it safer for the athletes, because you’d have less chance of making a mistake at the bottom and killing yourself.”

Oct. 12, 2005


Norman Fost, MD, Professor and Director of the Medical Ethics Program at the University of Wisconsin, stated the following in a July 2004 article published by Virtual Mentor titled “Performance-Enhancing Drugs in Sports”:

“Enhancing human bodily function is, of course, common in health care on the planet Earth. Pediatricians enhance the immune system of children by administering vaccines. Innumerable researchers, with public funds, try to extend the normal life span. And of course, coaches, trainers, and physicians work feverishly to enhance athletic performance in hundreds of ways, often with assists from unnatural machines, diets, supplements, and drugs.

It is now standard practice…for long-distance runners and bicyclists to raise their hemoglobin concentration to unnatural levels to enhance performance. There is no moral outrage about this if it is done by simply working at a high altitude for a few months before the competition, or sleeping in a low-oxygen tent. But if an athlete autotransfuses his own natural blood before an event, or uses the approved version of erythropoetin, he is accused of ‘blood doping’ and may be banned for life.

If enhancement is the moral linchpin of this policy, we should be equally critical of all athletes who seek to enhance their performance, whatever the method.”

July 2004


Bennett Foddy, DPhil, Postdoctoral Fellow in Bioethics at Princeton University, and Julian Savulescu, PhD, Professor of Practical Ethics at the University of Oxford, in their June 2007 Principle of Health Care Ethics article “Ethics of Performance Enhancement in Sport: Drugs and Gene Doping,” wrote:

“Playing sport at an elite level is not suicide, but neither is steroid use. To be sure, elite athletes are healthier on average than any morbidly obese person. But elite athletes in some sports can expect to have a serious medical problem every year or two.

This is not true of EPO, taken at a reasonable dosage. Even at very high dosages, and even if we take into account the poorly-substantiated rumours of EPO-related deaths, EPO does not present any risks that cannot be found from just over-training or especially from hypoxic training. If you have a low haematocrit for genetic or dietary reasons, EPO could actually improve your health.”


CON (no)


Nathan Cardoos, MD, Assistant Professor in the Department of Family Medicine at Boston University, as quoted by Sarah Wells in an Apr. 15, 2018 article, “Blood-Doping: How Elite Should Athletes Be?,” available at, stated:

“The main reason [blood-doping is illegal] is that they are dangerous; they can lead to heart attack, stroke and blood clots… Do we want to see superhumans doing superhuman things? If that’s the case, maybe we should let people push the boundaries of sport. [But] to me, the line is really what’s going to potentially cause harm to the athletes. [It’s] not fair to expect an athlete to put themselves in harm’s way [to] compete.”

Apr. 15, 2018


Mario Cazzola, MD, Editor-in-Chief of Haematologica, wrote the following information in a June 2000 article titled “A Global Strategy For Prevention and Detection of Blood Doping With Erythropoietin and Related Drugs,” published by his journal:

“As physicians, one of our major duties is to prevent diseases, and we have sworn this with the Hippocratic Oath. Since blood doping exposes athletes to several medical risks, we must be against blood doping, and more generally against any form of doping. Blood doping is not an abstract, intellectual challenge on how to circumvent sports regulations licitly, but a betrayal of the Hippocratic Oath for the physicians who are involved in it. Sport is intended to improve people’s health, doping worsens it.”

June 2000


Geoffrey Wheatcroft, a British journalist and writer, wrote the following in a May 28, 2006 article titled “Illegal Drug Use Makes Cycling a Blood Sport,” published by the Independent News and Media Corporation:

“An argument has been made that athletes should be able to take anything they like. But apart from the fact that doping is cheating, it is very dangerous. Steroids have several unpleasant side effects – Bonds’s former girlfriend says that he had acne on his back and was often impotent – but EPO is much worse. It increases energy by thickening the blood, but this makes it harder to circulate. That’s why we knew all too well when it arrived on the sporting scene. Between 1987 and 1992, seven young Swedish orienteering athletes and 20 Belgian and Dutch cyclists died mysteriously from nocturnal heart attacks.”

May 28, 2006


Jay P. Granat, PhD, Psychotherapist and Founder of the Stay In The Zone website, stated the following in his Sep. 27, 2005 blog entry titled “Sports Psychology: How to Stop Blood Doping in Sports”:

“Where the dangers of blood doping are concerned, I pointed out the following points:

1. Research on doping indicates that it can harm the immune system,cause infections, serious clots and death.

2. I have had several patients who were involved with doping and steroids and they present like addicts. They believe they can not perform or cope without using these substances. We don’t need more addicts in sports or in society at large.

3. We have enough instances of cheating in sports, in politics and in business. We don’t need another way for people to bend or break the rules.

4. The beauty of sport is you have athletes working hard and competing against one another. The winner in these contests should be the athlete with the most skill and with the best performance – not the athlete with the most devious pharmacist or transfusionist.”

Sep. 27, 2005