Although no test for EPO existed when the drug began to infest the peloton, the UCI by 1998 set a 50% hematocrit cutoff, above which a rider would be held out of a race to protect his health. The hematocrit is a measure of oxygen-carrying red blood cells. Riders with the biggest gap between their natural hematocrit level and the doping limit could realize the greatest relative benefit from EPO. In his book The Secret Race, Hamilton notes that his natural level was 42%, so he could add 19% more red blood cells without worrying about a positive test. "That might be one of the reasons Hamilton's performance increased so rapidly when he started taking EPO," co-author Daniel Coyle writes in a footnote.
O'Reilly, the former Postal soigneuse, showed SI the June 10, 1999, page from her diary, in which she recorded a conversation with Armstrong during the Critérium du Dauphiné Liberé in France: L. was 41 today + when I asked what could he do about that he just laughed + said you know what everybody does. From a hematocrit of 41%, Armstrong could increase his proportion of red blood cells by 22%.
Anyone who thought I would go through four cycles of chemo just to risk my life by taking EPO was crazy.
—Every Second Counts
There's a reason doctors at the Indiana University Medical Center wanted to know from Armstrong—who was in Indianapolis to be treated for stage III testicular cancer in October 1996—whether he had used performance-enhancing drugs: We're still learning precisely how athletes' health is affected by drugs they might have abused. According to affidavits by Frankie and Betsy Andreu, Armstrong told doctors that day that he had used EPO, human growth hormone, cortisone, steroids and testosterone. Apparently even Ferrari wondered about their effects. Landis (far right, with Armstrong) previously told SI, "When we were on a training ride in 2002, Lance told me that Ferrari had been paranoid that he had helped cause the cancer and became more conservative after that."
A 2006 paper in the journal Clinical Endocrinology, cited on Livestrong.com, raises concerns about the use of human growth hormone, which can elevate levels of insulin-like growth factor (IGF-1), a substance that has been linked to cancer in lab animals and humans. There's nothing to confirm Ferrari's reported fear that doping actually caused Armstrong's cancer, but IGF-1 and EPO, which is also classified as a growth factor, might well have caused the illness to spread as rapidly as it did. According to Dr. Otis Brawley, chief medical officer of the American Cancer Society, both substances may hasten the growth of an existing tumor. In fact, some cancer drugs, known as angiogenesis inhibitors, work by blocking the action of growth factors.
Travis Tygart's unconstitutional witch hunt ... [is] in opposition to all the rules.
—Armstrong on Aug. 23
In fact, in response to Armstrong's legal challenge to USADA's standing to press its case, U.S. District Judge Sam Sparks affirmed that the USADA protocol—neutral arbitrators in an open forum, weighing evidence that must meet a standard of "clear and convincing"—conforms to due process. In accepting a license to compete from USA Cycling, Armstrong consented to those very disciplinary procedures. And as an elite triathlete after he retired from cycling, he remained subject to USADA's jurisdiction until Aug. 23, when he was banned.
Back when the FDA and Jeff Novitzky were building a criminal case against him, Armstrong seemed to welcome USADA's scrutiny. As recently as January 2011, after SI ran a story pegged to the FDA probe, Armstrong tweeted, "Great to hear that @usada is investigating some of @si's claims. I look forward to being vindicated." Now that USADA has published its report, Armstrong's attorney Tim Herman last week denigrated its witnesses as "axe-grinders" and "serial perjurers."