Erythropoietin, called EPO, is banned from sports because of claims it can enhance an athlete's performance unfairly.

A systematic review couldn't find any benefit but it found considerable risk of harm.

Professional cycling remains a popular sport though its image has been tainted by high-profile doping cases. EPO, a blood-cell stimulating hormone, recently made headlines, when the self-appointed United States of America's Anti-Doping agency (USADA) claimed that it was used by record seven-time Tour de France winner Lance Armstrong. 

If so, according to the systematic review, so what?  He got no benefit and no one would criticize him for wearing weird magnetic bracelets or homeopathy or eating organic food if he felt like it helped.  Normally, EPO is used to treat people with anemia, where its effect on each patient is carefully monitored. EPO thickens a person's blood, which can lead to an increased risk of clots. These clots obstruct blood flow to areas of tissue, and so oxygen doesn't get to the cells and they die, damaging the organ. If the organ is your heart or your brain this can be particularly dangerous, potentially resulting in heart attack or stroke. 

"Athletes and their medical staff may believe EPO enhances performance, but there is no evidence that anyone performed good experiments to check if EPO would actually improve performance in elite cyclists," says lead researcher Professor Adam Cohen, who works at the Centre for Human Drug Research in Leiden, The Netherlands. Researchers work hard to prevent patients taking drugs that don't work or have dangerous side-effects.

"So why should the standards be different for the same drugs used in athletes? Although doping is forbidden, the pressure to win in sport is so great that some athletes seem to be willing to try any way of getting ahead of their competitors. When elite athletes and their coaches discover that there is no evidence of benefit and clear risk of harm, I hope many may reconsider trying to cheat. Education may work where attempts at enforcement have failed," says Cohen. "I believe there is a clear need for high-quality research to investigate the effects of supposedly enhancing drugs in sport. If, as is expected, many substances in current use are found to be ineffective it will help keep our athletes safe and improve confidence in sporting results."

Published in British Journal of Clinical Pharmacology