Does Roger Clemens’ personal and/or sexual relationships have any bearing on his alleged use of performance enhancing drugs (or vice versa)? Already, the blogosphere is suggesting that steroids may have caused Clemens’ infidelity. But as far as the legal proceedings are concerned, Yahoo Sports’ Tim Brown doesn’t think his philandering has relevance to his alleged steroid use (“We’re no closer to the truth about Clemens,” April 29)

Clemens had an affair with a country singer, according to the New York Daily News. Therefore, the thinking goes, the defamation case against his accuser and former trainer is weak. Didn’t we already have a pretty good notion of that? As for claims in the petition regarding marital purity, well, it doesn’t address that, exactly. It does claim that McNamee has sullied “Clemens’ good reputation,” and has caused him to suffer “mental anguish, shame, public humiliation and embarrassment.” Presumably, the Daily News report has piled onto that, but what does a private relationship have to do with Clemens’ public reputation, whatever it may be? I’m sure the lawyers will enlighten us.

Now the attorneys chime in…

Richard Emery, McNamee’s attorney, believes the news of an extramarital affair by Roger Clemens clearly hurts Clemens’ defamation lawsuit claiming McNamee lied about Clemens use of anabolic steroids and human growth hormone (“Roger Clemens had 10-year fling with country star Mindy McCready,” April 28).

“The issue in Roger’s suit against McNamee is Roger’s reputation and how it has been damaged,” said Richard Emery, one of McNamee’s lawyers who is handling the defamation suit. “If it’s proved that he’s a philanderer, his reputation is already damaged. When you sue for defamation, you put your whole reputation in the community at issue. Anything is fair game, including his claim of sanctimonious purity. We would cross-examine him and other witnesses who might impact on his alleged behavior. We would probably subpoena her and witnesses who knew [of the relationship]. He’s a ‘family man’ – he implies that. It’s about what his damages are. All is fair game.”

Richard Emery believes the lawsuit will be dismissed.

“If the case heads to trial and is not dismissed, as we feel it should be, we will be calling [McCready] as a witness,” Emery said.

“The point is whether he was damaged by the allegations that he used steroids – he claims he was hurt. But if there are other women – and there’s not just one case, but many – and he holds himself out as a family man and an American paradigm, it’s relevant.

“None of this would have been revealed but for his lawsuit and sanctimonious testimony before Congress.”

But Rusty Hardin, Clemens’ attorney, tells the press that Roger Clemens’ (alleged) infidelity is irrelevant to the veracity of Brian McNamee’s statements regarding Clemens’ steroid and growth hormone use.

“I think it’s totally irrelevant to the issue of whether Brian McNamee is telling the truth about Roger using human growth hormone and steroids,” said Hardin. “The character trait that you put in issue should be the character trait that the defamatory statement was made about.”

I guess the specter of anabolic steroid use is so bad that Clemens would rather publicly embarrass his wife Debbie Clemens with revelations of an extramarital affair and her illegal use of human growth hormone a Sports Illustrated swimsuit photo shoot than admit steroid use. At least, Roger Clemens will have officially gone on record as officially denying steroid use.

Senators Charles Schumer, D-N.Y., and Chuck Grassley, R-Iowa, have dropped language in the bill that would have put HGH on the same legal plane as anabolic steroids, a move that would have severely limited access to the synthetic hormone.

For example, under the bill’s original language, HGH would not have been widely available through the mail and would not have been available in longer than six-month supplies. Because doctors specializing in childhood growth disorders often are far from patients, such controls could have caused hardship for families with children using the drug.

The atmosphere of steroid hysteria resulted in overwhelming bipartisan support for the original HGH bill practically guaranteeing passage of the legislation. When it comes to steroids and performance enhancing drugs, it appears that emotional arguments generally trump intellectual arguments. But fortunately, and surprisingly, the Sen. Schumer and Sen. Grassley rationally examined the evidence of the adverse consequences, particularly for children, of making HGH a Scheduled-III controlled substance. 

“We’ve ran into some things that we didn’t anticipate. We were enlightened by the parents whose children legitimately need HGH,” Grassley told USA TODAY on Tuesday. “Making it (a more tightly controlled substance) would have created a lot of red tape for them.”

Sadly, Sen. Schumer and Sen. Grassley are not students of history when it comes to the Controlled Substances Act; otherwise, they would already known how political misuse of the Controlled Substances Act (especially involving doping in sports) can adversely affect availability of pharmaceuticals for patients who needs these therapies for health, wellness, and survival. The addition of anabolic steroids to the Controlled Substances List with the Anabolic Steroids Control Act of 1990 had adverse unintended consequences for untold numbers of patients who had legitimate medical indications requiring anabolic steroid treatment.

We can thank Sen. Mike Enzi (R-WY) and Sen. Richard Burr (R-NC), who were widely criticized for doing so at the time, for placing a temporary hold on the original HGH legislation thereby allowing reason to prevail over emotion in the Senate. But most credit should go to the MAGIC Foundation, a non-profit organization dedicated to “providing support services to the families of children afflicted with chronic and critical disorders, syndromes, and diseases that affect their growth,” for their activism in the matter.

The hotline, recommended by Sen. George Mitchell in his report on baseball and steroids and implemented by commissioner Bud Selig in January, is one of the tools the investigative unit is using to catch drug cheats, along with information from outside investigators.

Everybody is baseball is said to have access to the anonymous hotline which hopes to break the so-called “code of silence” of steroid use in baseball.

The first casualty of the hotline is said to be Jordan Schafer, a top minor league player, according to an anonymous MLB source contacted by the New York Daily News. Schafer was suspended for growth hormone use due to evidence of a “non-analytical positive.” This was obviously not the result of a drug test nor evidence in a governmental steroid-related investigation (“Braves prospect unable to clarify HGH charge,” April 9).

Jordan Schafer, 21, already has a Nike contract and a projected center-field spot with the Braves in 2009.

However, this is a bad incident at the beginning of his career. Schafer was playing for Class AA Mississippi after a breakthrough 2007 season in Class A that lifted him to the organization’s No. 1 prospect.

There are questions, but even team officials have not been able to get complete answers. Schafer was advised not to discuss matters with anyone..

The anonymous hotline is being used to investigate suspected steroid use (and other performance enhancing drugs) in both the minor and major leagues.

WADA refuses to worry about trivial genetic factors. WADA is loath to do longitudinal tests of athletes. WADA might find a variable that might refute their laboratory findings or challenge their presumption of laboratory perfection. WADA would never invest time and money doing pedigree studies to determine if a single metabolite above threshold for exogenous testosterone is a trait common in a family, or among a group of people found in a geographical region. But idiosyncratic individual differences in medicine have been documented in many pedigree studies. For example, hematocrit levels above 50% have been found in fathers and sons of elite cyclists. These hematocirt levels are inherited tendencies, not based on EPO doping. The same is true for testosterone/epitestosterone ratio(s) and may be true for Carbon Isotope metabolite delta/delta scores.

Personally, I’ve always been suspicious and critical of the arbitrary 50% hematocrit level as an indicator of EPO doping. Why? My hematocrit level has regularly and consistently exceeded 50% for the past 15 years and I’ve never used EPO. I may be an outlier, but I would venture to guess that a significant percentage of elite endurance athletes fall into the outlier category on various physiologic parameters.

The unreliability of the testosterone:epitestosterone ratio test (T:E ratio) and WADA’s insistence on its infallibility only further undermines the credibility of WADA.

It would be nice to believe that the isotope ratio mass spectrometry (IRMS) [used in the carbon isotope ratio testing (CIR) to detect exogenous testosterone use] is 100% reliable as WADA would suggest. But Velo Vortmax explains why we shouldn’t just trust WADA with this test.

The IRMS is an instrument that requires very precise controls of operation. The results of an IRMS is only as good as the laboratory performing the tests. Inexperienced laboratory personnel who cannot follow sequential steps in testing cannot be expected to arrive at the correct results. A valid IRMS is also only as good as the science behind the tests. A valid IRMS is only as good as the criteria required in WADA technical documents, by international standards, and by standardized criteria as to constitutes a positive result. WADA has failed in all these areas.

One hundred years from now will the scientists of the future shake their heads in amazement at our ignorance. Will they abhor the stupidity and mistakes of the anti-doping crusade? Will they be forced to restore the honor to “fallen” athletes?

Is it any surprise that there is a fair amount of skepticism regarding WADA’s new human growth hormone testing kits?

WADA says the out of competition testing for HGH will begin within weeks The test will be used at the 2008 Beijing Olympics. Additionally, a WADA spokesperson says the the HGH screening kits will be used to analyze previously frozen blood samples from athletes.

The kits will allow doping authorities to analyze blood samples that have been frozen from earlier tests, Howman said.

Given WADA’s secrecy regarding the HGH screening kit, very little is known about the efficacy of the doping test. Daniel Rosen, author of Dope: A History of Performance Enhancement in Sports from the Nineteenth Century to Today, writes on his blog about the criteria for a truly effective human growth hormone test.

• Because most of us produce HGH naturally, the test must be able to effectively distinguish between natural and synthetic HGH. One possible way to do that would be through the use of carbon isotope ratio testing — although there is no guarantee that this technique would be used, or that it is the only method for making the distinction.

• The amount each individual produces is variable, so the criteria for a positive test must take that variability into account.

• Most people produce progressively less HGH as they age, so the amount that would be normally present in a 20-year-old will be different than for the same person at age 40, for example.

• The test should have been thoroughly vetted by peer review, and multiple studies with large enough test groups to draw statistically significant conclusions.

It remains to be seen how effective the HGH test will be. We will most likely learn after the first high profile case puts the new test in the spotlight.

Doping in academia is common, with Provigil and Adderall being the drugs of choice amongst professors and students at university. Apparently these drugs make it possible to concentrate without getting distracted for long periods of time, and to never get sleepy when pulling an all-nighter.

The New York Times compares doping in sports to doping in academia (“Brain enhancement is wrong, right?” March 9).

But is prescription tweaking to perform on exams, or prepare presentations and grants, really the same as injecting hormones to chase down a home run record, or win the Tour de France?

There was no shortage of people cited who saw ethical concerns with the use of drugs like Adderall and Provigil for non-medical purposes.  

Some argue that such use could be worse, given the potentially deep impact on society. And the behavior of academics in particular, as intellectual leaders, could serve as an example to others.

But I was surprised to see one professor go on record in defense of pharmaceutical cognitive enhancement.

“I think the analogy with sports doping is really misleading, because in sports it’s all about competition, only about who’s the best runner or home run hitter,” said Martha Farah, director of the Center for Cognitive Neuroscience at the University of Pennsylvania. “In academics, whether you’re a student or a researcher, there is an element of competition, but it’s secondary. The main purpose is to try to learn things, to get experience, to write papers, to do experiments. So in that case if you can do it better because you’ve got some drug on board, that would on the face of things seem like a plus.”

Dr. Mariah Farah didn’t offer a defense of doping in general (as Professor Norm Fost has done in defense of doping in sports). Dr. Farah comments almost appeared to be an elitist defense – doping in sports is about competition and winning but doping in academia is about learning. Therefore, Farah seemingly suggests that the nobleness of learning may justify doping whereas the selfish competitiveness of sports is unjustified.

Doping for eggheads is good, but doping for athletes is bad.

Source: Wikipedia

The scientific and anti-doping community continue to struggle with the development a test for exogenous growth hormone in athletes. They haven’t even been able to produce scientific evidence that growth hormone enhances athletic performance in spite of anecdotal evidence [from athletes and strength coaches] that this is the case.

But science continues to do a good job at finding weakness in the doping controls currently in place. Tip of the hat to Trust But Verify for alerting us of a new study which, among other things, tells us exactly how much exogenous testosterone some athletes can use and still pass the drug test.

The study reveals serious weaknesses in the testosterone:epitestosterone ratio test used by WADA and other anti-doping organizations (“Doping Test in Sports Confounded by Common Genetic Trait,” March 21).

The current first-line defense for detecting testosterone abuse in sports is to measure the ratio of two chemicals in a spot urine test: testosterone glucuronide (TG) and epitestosterone glucuronide (EG). TG is a by-product of testosterone in the body; it increases as the amount of testosterone increases. EG is unrelated to testosterone metabolism, and serves as a reference point in testing.

In doping tests, any ratio above four, according to the International Olympic Committee, should be considered suspicious and lead to further testing.

It appears that certain genotypes are more likely to have false negatives (athletes use testosterone but don’t get caught)and other genotypes are more likely to have false positives (innocent athletes test positive for steroid use).

The production of TG from testosterone, however, is primarily controlled by an enzyme (UGT2B17), which is produced by a specific gene. Common variations to this gene may give rise to wildly different testing results, even when the same dose of testosterone has been taken.

For their study, the researchers screened 145 men for the insertion (ins) or deletion (del) of this gene. Among the participants, 15 percent had no copies of the gene (del/del), 52 percent had one copy (ins/del), and 33 percent carried two copies (ins/ins).

From this group, the researchers selected 55 men (17 del/del, 24 ins/del, and 14 ins/ins) to receive a single 360 mg dose of testosterone. The men were then routinely tested over a 15-day period for the telltale signs of doping.

If you’re a genetically gifted athlete (i.e. you lack the gene that produces the enzyme UGT2B17), you can take an whopping injection of at least 360 milligrams of testosterone without getting caught by the testosterone:epitestosterone ratio test (T:E ratio). This testosterone loophole in drug testing has been known by athletes for decades (anecdotally). It is nice to have solid scientific evidence to confirm it.

A full 40 percent of the del/del subjects never reached the detection threshold in a standard doping test. “Nearly half of the individuals in our study who carried this genetic variation would go undetected in a regular doping test after a single 360 mg dose of testosterone,” said Dr. Schulze.

If you were born without the genetics to beat a drug test, then you have a fair chance of failing the drug test even if you are innocent.

Of equal interest, 14 percent of the ins/ins subjects were naturally over the detection threshold even without receiving a testosterone injection. Based on an earlier study, the researchers estimate that this would give a false-positive rate of 9 percent in a random population of young men. “False positive results are not only of concern for the legal rights of the sportsman,” said Dr. Schulze, “they also yield extra workload for the doping laboratories.”

Maybe athletes will start taking advantage of relatively inexpensive personal genome services to learn things like the likelihood of side effects from anabolic steroids and the likelihood of being able to get away with using banned substances?

Most importantly, this study provides solid evidence that innocent athletes can be falsely accused when relying on the T:E ratio test.

A few other things learned:

• A level playing field doesn’t exist even at the genotypic level even when it comes to the ability escape doping detection

• Could there be a rogue chemist who discovered a pharmaceutical drug that can block the UGT2B17 enzyme?

• Certain “ethnic populations” are more/less likely to get caught when using banned substances like testosterone (e.g. East Asians and Swedish Caucasians).

I look forward to reading the full text of the study when it is released.

The paper “Doping Test Results Dependent on Genotype of UGT2B17, the Major Enzyme for Testosterone Glucuronidation” will appear in the June issue of [Journal of Clinical Endocrinology & Metabolism] JCEM, a publication of The Endocrine Society.

Claims that growth hormone enhances physical performance are not supported by the scientific literature. Although the limited available evidence suggests that growth hormone increases lean body mass, it may not improve strength; in addition, it may worsen exercise capacity and increase adverse events. More research is needed to conclusively determine the effects of growth hormone on athletic performance.

This confirms what J.C. Bradbury, Ph.D. has been saying all along. Bradbury is the Associate Professor of Economics at Kennesaw State University and author of the Sabernomics blog where he has argued again and again that human growth hormone does not enhance athletic performance. According to Bradbury, there is no scientific evidence documenting the performance enhancing effects of growth hormone. He confidently dismisses any effect of HGH in MLB:

The impact of HGH on home runs in today’s game is zero. If a player is dumb enough to take this stuff, let him go right ahead.

Dr. Bradbury is correct at least when it comes to the lack of scientific evidence.

But he may still be wrong about growth hormone’s effects on sport performance.

Athletes knew anabolic steroids worked (anecdotal evidence) for DECADES before available scientific evidence supported this belief. There are several prominent bloggers who argue that, in spite of limited absence of scientific support, growth hormone does improve athletic performance.

Lou Schuler of Male Pattern Fitness points to the credible anecdotal evidence to support his views on growth hormone.

Athletes and their doctors believe the drugs work. I’ve been hearing this for years from the people I come across, who’re mostly trainers and strength coaches. I get a chance to chat with researchers or former pro athletes from time to time, and I hear the same thing. The only way you can convince yourself that human growth hormone doesn’t speed recovery and/or enhance performance is to ignore all the anecdotal evidence that comes from knowledgeable insiders who believe it does.

Lou addresses the shortcomings and limitations of the recent review in an article today (“Don’t Those Stupid Athletes Realize Their Drugs Don’t Work?,” March 18)

Once again, a study attempts to convince us of something that isn’t likely to be true…

To its credit, the story by the Associated Press calls bullshit on itself, citing the litany of limitations to this kind of reasoning that I’ve noted on MPF here and on my original blog here:

• Clinical studies aren’t conducted on elite athletes, and don’t measure “performance” in any way that would be meaningful to an athlete. For example, they don’t consider whether it would help them recover faster in between workouts, or have less downtime because of minor injuries.

• They don’t use the doses elite athletes use, and they can’t possibly take into account the combination of drugs an athlete might employ. Is growth hormone more effective when used simultaneously or in some sort of sequential pattern with anabolic steroids? You can’t test that in a lab.

• The studies can’t possibly track long-term use of HGH, so if there’s a chronic, cumulative effect that’s greater than the acute, short-term effect, you’d never know from the published research.

Gary Gaffney, M.D., University of Iowa School of Medicine, also addresses the review study. Gaffney believes growth hormone has beneficial effects on athletic performance; however, these effects may only be evident in its synergy with other performance-enhancing drugs (“Review from Stanford says HGH no benefit as PED,” March 17).

As we pointed out in the Huffington Post, HGH by itself may not be anabolic. There is evidence that the hormone is synergistic with anabolic steroids (or insulin or T4), which means that the effects of these hormones add to each other. Further, we don’t know the effects of the drugs on the most genetically gifted athletes – professionals.

However, a study is a study. HGH by itself in these doses used in young healthy men does not appear to be an impressive anabolic drug.

Given that athletes were decades ahead of the scientific community when it came to anabolic steroids, I tend to give credence to the anecdotal evidence. Also, based on growth hormone’s use in bodybuilding (whose participants are far ahead of athletes in other sports when it comes to pharmaceutical enhancement), there is a fair amount of support for the synergistic effects of growth hormone combined with anabolic steroids and other drugs.

Nelson Vergel, HIV activist and co-author of Built to Survive, published a letter on his blog that outlines how patients with legitimate medical needs for these pharmaceuticals suffer as a result of the steroid hysteria and legislation that limits the availability of anabolic steroids and human growth hormone (“Hearings on Steroids in Sports and the Impact on Treatments for HIV and other Medical Conditions,” March 12).

The difficulty now is that anabolic steroids are becoming much less available legally because of Federal pressure upon producers. The anabolic steroid most successfully used over the years to combat wasting has been nandrolone decanoate. Up until recently, this product was produced by Watson Pharmaceuticals. In 2007, however, Watson stopped producing nandrolone. Instead, it is promoting Oxandrine, an oral steroid that is less effective and has more adverse side effects, but is also proprietary and therefore commands a higher price. Since then, anyone who needs to use nandrolone must go to compounding pharmacies, which will then produce the medicine on a custom order. At this time, the only anabolic steroids that may be used legally in the United States are Oxandrine and nandrolone. So the choice is Watson’s expensive, less effective, propriety product or use of the compounding pharmacies.

This situation presents two major problems for patients who need anabolic therapies. The first is that a prescription filled by a compounding pharmacy is not covered by insurance or AIDS Drug Assistance Programs (ADAPs), so use of nandrolone is an out-of-pocket expense. Many patients suffering from HIV are in difficult economic circumstance. The added expense frequently puts the medicine out of reach.

The other problem is that compounding pharmacies are now under heavy scrutiny by the Drug Enforcement Agency to ensure that prescriptions are for legitimate medical needs. In theory, this would sound reasonable, but, in practice, the added delays, pressure and bureaucratic requirements have caused many compounding pharmacies to shy away from production of nandrolone. The most popular, Applied Pharmacy of Alabama, was providing the product reliably and at a reasonable price. However, the DEA insisted that the pharmacies verify the medical necessity of each prescription. That is not the role of a pharmacy. That is the role of the doctor writing the prescription. So the DEA regularly comes into the Applied Pharmaceuticals, gathers up all their records and keeps them for an unreasonable amount of time for review purposes. This amounts to blatant harassment solely to suppress production of a legitimate medication. For this reason, Applied Pharmacy has announced that it will no longer provide nandrolone or other hormone-based products. Other compounding pharmacies have similarly so halted production, and this has caused an increase in prices among the remaining producers and confusion among HIV prescribers who wrongly assume that nandrolone is no longer available in the U.S.

I have generously excerpted from this detailed letter written by Mark A. Meier, a constituent in Representative Nancy Pelosi’s district. I encourage readers to carefully read the entire letter at Nelson’s HIV blog to see see what is at stake.

Here’s the problem: The proposed legislation would re-classify HGH as a Schedule III drug, increasing penalties for its illegal use and limiting access in several ways. The penalties are fine, the parents agree. Limiting access for growth-challenged kids is the deal breaker.

The Champs, for example, would need to go to Mount Sinai Hospital in Manhattan once every month for a new prescription, which would last 30 days. Currently with each visit, they are able to obtain a three-month supply of HGH, with two refills. They only need to go once every nine months. Meanwhile, their insurance co-pays would triple for the extra doses.

Bondy blames the athletes for this problem. However, the immediate culprit is obviously Congress’ ill-informed attempts to eliminate steroids in sport by expanding the Controlled Substances Act to include non-addictive human growth hormone.

I do not understand why Congress thinks scheduling performance enhancing drugs is an effective tool for eliminating steroids in sports. I am not aware of many any professional athletes who have been prosecuted under the Anabolic Steroids Control Act. I can not name a single athlete who has failed a doping test in the United States and was criminally sanctioned as a result. History tells us that the Controlled Substances Act is ineffective at punishing professional athletes who use steroids. Including human growth hormone on the Controlled Substances list will only be another failure in more ways than one.

Now, perjury is another story. This seems to be a highly effective tool for punishing athletes who use steroids based on perjury investigations involving Barry Bonds, Marion Jones, Tammy Thomas, and Roger Clemens.