Reports of a “rash of positive steroid tests” in the NFL by news websites here and here and here and here are highly misleading and false since none of the players are alleged to have tested positive for steroids by the NFL. Nonetheless, MSNBC stated that one player tested positive for anabolic steroids with the headline ”Report: Saints’ McAllister positive for steroids“, but deep in the article reported the truth that it was bumetanide. There are even plausible indications these may have involved inadvertent doping from weight loss supplements tainted with bumetanide.

First, the prominent anti-doping drug tester Don Catlin recognizes bumetanide as a masking agent but is surprised because it hasn’t been used in over twenty years.

“It can be seen as a masking agent because it produces so much water that it dilutes drugs in the system,” Catlin said Friday in a telephone interview. “But we haven’t seen it used by athletes to mask drugs in over 20 years.”

He added: “It is also banned because some athletes need to make weight and it helps flush water out of an athlete’s body. In general, though, it is used by physicians to control blood pressure and reduce the amount of excess water in the body.”

Secondly, some dietary supplements marketed for weight loss have been empirically shown to be contaminated with bumetanide. StarCaps by Balanced Health Products has been found to contain near therapeutic levels of bumetanide by a 2007 article in The Journal of Analytical Toxicology in spite of claims by the manufacturer that the product contained only natural ingredients.

Third, it appears that the NFL players who tested positive for bumetanide are not only denying the use of bumetanide to mask other performance enhancing drugs, but appear ready to appeal the findings.

Bryan Pittman is appealing.

Atlanta attorney David Cornwell, who has been hired to represent Pittman at his appeal on Nov. 3, issued a statement on Friday that said: “Bryan did everything humanly possible to comply with the NFL steroid policy, including obtaining doctors’ written authorization to take weight-loss medication. He did not use steroids.

Deuce McAllister is appealing.

“I’ve hired an attorney, and I’m going to let him do his job,” he said. “I will be playing this Sunday against the Chargers.”

Fourth, the source who leaked the story seems convinced that bumetanide was not used for masking steroids or amphetamines but solely as a weight loss supplement.

“I don’t think many of them are attempting to cheat, or even know it is on the list. We are talking big guys who have likely never seen a steroid in their life. My understanding of the steroid policy is that it was intended to catch cheaters or people using performance enhancing substances to gain a competitive edge. These guys don’t fall into that category,” said the source.

The only conclusive evidence to support inadvertent doping would be the existence of sealed dietary supplements that can be proven to be tainted through testing. Otherwise, suspicions of doping with other substances will persist.

Gatorade is Major League Baseball’s “official sports drink.” So instructions were sent that no player could be seen drinking anything but Gatorade in the dugout. Not even Aquafina, which is the “official water” of MLB. Not even bottles of water with the labels removed.

White Sox clubhouse personnel said if players take bottled water onto the bench, all the bottled water will be removed from the clubhouse as punishment.

This policy only reinforces the appearance of a pro-steroid agenda by Major League Baseball. MLB sends the following message to baseball fans.

So remember, the biggest threat to baseball isn’t steroids or HGH or amphetamines or runaway ticket prices or four-hour games.

It’s water.

Just think of the contradictory message this sends to the youth of Coach Connolly’s high school football team!

Gary Gaffney, M.D., from the University of Iowa College of Medicine, offers a defense of TUEs in his blog:

If we support the idea of medical disabilities, then those disabilities should be treated.  A fine line may be drawn between those who would correct medical problems: vision, ADHD, and legitimate endocrine problems v. those who abuse the treatments.  The same medications to treat these conditions could be used as  PEDs; however, a proper diagnosis and prescription would prevent the TUE rule gamed to ‘cheat within the rules’.

There is a critical difference between treating a disease, and using a drug in a healthy athlete for a competitive advantage.  If well documented, an athlete deserves treatment for a medical condition, even with a banned drug.

I generally agree with Dr. Gaffney. I have always had a problem with “banned substances lists” that prevented athletes from medical treatments and medical comforts afforded to the rest of the non-drug-tested population. This is the reason for the existence of therapeutic use exemptions.

But any use of performance-enhancement drugs is problematic for anti-doping organizations:

(1) Even a therapeutic dosage of a performance-enhancing drug (or any other corrective medical procedure) for a legitimate medical condition can improve the athlete’s performance above and beyond mere correction of any disorder. Even a 1-2% improvement in performance can be significant for an elite athlete.

(2) Legitimizing performance-enhancing drug use for athletes with therapeutic use exemptions may not result in a desired outcome of “returning to normal” but a desired outcome of “being better than normal”.

(3) Also, this is all premised on the belief that the athlete is at a competitive disadvantage without the corrective (pharmaceutical) treatment.

A good example of the aforementioned potential problems can be seen in discussions of other corrective medical procedures used by athletes, namely laser eye surgery or LASIK (Laser-Assisted In Situ Keratomileusis).

Tiger Woods was hardly at a competitive disadvantage with less than perfect vision. He apparently won 5 majors golf titles before correcting his vision. And with the procedure he returned to the course with better than normal vision, 20/15. Numerous other athletes have taken advantage of a corrective medical procedure for a legitimate medical condition to obtain a clear competitive advantage.

Golfers Scott Hoch, Hale Irwin, Tom Kite, and Mike Weir have hit the 20/15 mark. So have baseball players Jeff Bagwell, Jeff Cirillo, Jeff Conine, Jose Cruz Jr., Wally Joyner, Greg Maddux, Mark Redman, and Larry Walker. Amare Stoudemire and Rip Hamilton of the NBA have done it, along with NFL players Troy Aikman, Ray Buchanan, Tiki Barber, Wayne Chrebet, and Danny Kanell. These are just some of the athletes who have disclosed their results in the last five years. Nobody knows how many others have gotten the same result.

And then there’s the widely accepted Tommy Johns surgery. The therapeutic use exemptions for performance-enhancing drugs and permissible corrective medical procedures complicate the ethical discussion. If the patient were anyone other than a drug-tested athlete, there would be no hesitation on the part of the doctor or patient to make them as healthy and strong as medically possible – not just normal.

Congressman John Tierney (D-MA) revealed that Major League Baseball has granted over 100 therapeutic use exemptions to athletes for amphetamines and related stimulant drugs to treat ADHD. Of course, since the focus of the Mitchell report and the Congressional hearings are on the evils of steroids, the continuing problem of amphetamines in baseball will likely not be seriously investigated at this point.

http://oversight.house.gov/story.asp?ID=1685