I started thinking, if I was to come up with a baseball variant to try and take on MLB, what would it look like? Well, it would be baseball, but, I’d market it as a faster, more exciting version. I’d make the following rules changes to try and re-enforce the brand [...]

No steroid testing. Leave that for the cops. This is baseball – let’s the conversation revolve around the action on the field, not off of it.

In a previous post, Markson expands on his feelings about steroids in sports with some insightful comments on the issue. Sports has had to deal with advances in technology in every aspect of the game including performance enhancing drugs. More often than not, sports have embraced advances in technology and incorporated them into the game. Sports have recently had a conflicted position with regarding to technological advances in pharmacological ergogens. But it’s difficult to counteract technology (progress).

The thing about technology is that it always evolves at a rate much faster than efforts designed to stop it. Don’t believe me, ask the recording industry. In the case of performance enhancing drugs, the drugs will always outpace the tests designed to detect their presence/ use. To try to combat this, testing has to become more frequent, more intrusive. Like anything the more frequent and more intrusive you make it, the more likely their will be false results. Which means there need to be procedures around appealing tests, results, etc. All of a sudden, testing requires an infrastructure, and then you’re in trouble.

Does this sound familiar? It should. It’s basically how the Tour de France and track and field operate. Bet you have no clue who won last year’ tour de france, but know Floyd Landis cheated. Likewise, bet you have absolutely no clue who holds what records for any track and field events, but are very familiar with the Marion Jones scandal.

The problem with false positives is very disturbing. The problem is compounded by the flimsy standards of evidence required for guilt by anti-doping agencies. I can’t imagine the degree of uproar if our own imperfect criminal justice system in the United States abandoned “beyond a reasonable doubt” and “preponderance of the evidence” and adopted the “comfortable satisfaction” standard advocated by the United States Anti-Doping Agency (USADA).

Markson continues by discussing how the ultimate outcome is the destruction of the sport.

This is what happen when you try to use policing measures to keep up with technology. The drug tests, their results, the appeals, etc. actually become the only interesting/ memorable thing about the sport. The become the brand of the sport. And, since this isn’t nearly as fun/interesting as remember the actual games or plays themselves, the fans eventually abandon.

Baseball should stick to the business of balls, strikes, beer and caps and leave police work to the pros [...]

At the end of the day, juice or no juice, talent and skill are still the ultimate arbiter of performance.

Most elite athletes strive to be the best at their sport without qualification. And most fans want to see the best without qualification. After all, who really cares who is the best cyclist riding on a bike that costs no more than $200 or the best baseball player who doesn’t lift weights? Let’s see the best.

“The [NASCAR] community polices the community,” Helton added in an interview with The Associated Press. “The positiveness of all the drivers talking and everything, I think, echoes the responsibility that exists in this sport to avoid all that and to police all that. That’s why we think that the reasonable suspicion policy works as an umbrella from a NASCAR perspective.”

Commentator David Caraviello went a step farther, not only defending the “reasonable suspicion” drug testing policy, but also asserting that NASCAR does not have any type of problem with performance-enhancing drugs either (“Addressing a drug problem that is not a problem at all,” April 16).

The reason the Olympics began drug testing in 1976? Steroids. The reason the NFL began drug testing in 1990? Steroids. The reason tennis began drug testing in 1993? Steroids. The reason the NHL began drug testing in 2006? Steroids. The reason professional cycling conducts drug tests? Steroids. The reason the PGA Tour is implementing a drug-testing policy next year? Steroids. The reason for the recent upheaval in Major League Baseball? Steroids.

In each of those sports, the athlete can clearly benefit through the use of a performance-enhancing drug. Not so in NASCAR, where the raw skills are all bundled in reflex and nerve. Harvick can take all the tetrahydrogestrinone he wants, and it’s not going to help him with the Sprint Cup title.

While the performance enhancing benefit of anabolic steroids in NASCAR is questionable, Caraviello seems to pretend that the only type of performance enhancing drug is anabolic steroids. Obviously, this selective ignorance is self-serving in his argument against the implementation of anti-doping programs. There are no doubt several pharmaceuticals that can enhance the “raw skills… all bundled in reflex and nerve.” Just ask the U.S. military about performance enhancing drugs such as Provigil and Adderall that are mandatory for some fighter pilots.

But Caraviello is correct is stating that NASCAR is categorically different from football, baseball, basketball, etc. Perhaps NASCAR should consider a testing program that only tests fror pharmaceuticals and drugs that HURT performance. In most sports, a competitor who uses a drug that diminishes performance would be welcome to other competitors; in NASCAR, the use of such drugs may actually do more harm than good for other competitors by increasing the risk of serious injury and death. Ironically, the use of performance enhancing drugs that make fellow competitors better drivers might actually make the sport safer!

Disgraced former Tour de France winner Jan Ullrich is to pay out a million euro fine to end a fraud case which German prosecutors have been investigating, Focus news magazine reported on its Web site Saturday.

Prosecutors accused the 1997 Tour de France winner of taking performance-enhancing drugs, leading under German law to fraud charges against the 34-year-old on the basis he deceived the public, sponsors and his team.

The United States does not have laws that specifically criminalize doping in sports. However, the Anabolic Steroid Control Act of 1990, passed as a direct result of doping scandals in sports, criminalizes the non-medical uses of anabolic-androgenic steroids. One of the primary objectives for the act has been to combat “cheating” in sports although it has been largely ineffective for this purpose. Instead, the federal government has had some recent success using perjury laws to prosecute athletes who use steroids. Maybe sports fraud prosecutions will join perjury as an additional way of making examples out of “immoral” athletes.

Under federal sentencing guidelines, Thomas faces a sentence that likely would range from probation to about two or three years in federal prison for the perjury convictions.

Thomas was specifically accused of lying to the grand jury about using steroids and obtaining performance enhancing drugs from Illinois chemist Patrick Arnold, a key Balco figure who pleaded guilty to manufacturing designer steroids and providing them to elite athletes through the now-defunct Peninsula laboratory.

Tammy Thomas already received a lifetime ban from competitive cycling for doping violations several years. This effectively ended her career as a cyclist. The conviction for perjury in the government’s case against Thomas may have effectively ended the pursuit of a second career as an attorney (“Tammy Thomas found guilty of perjury,” April 4).

“I already had one career taken away from me,” she yelled. “Look me in the eye. You can’t do it.”

Thomas then turned to a prosecutor and shouted, “Look me in the eye …. You like to destroy people’s lives.”

 The government has succeeded in its unstated goal of making an example of an athlete using steroids. Is this justice served?

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.

Gaffney takes note of the lack of empirical research examining the performance enhancing effects of drugs that has historically resulted in mainstream medical organizations failing to recognize performance enhancing drugs. Given this along with results seen in “experiments of nature,” Gaffney feels it is reasonable to conclude that GH has performance enhancing effects:

Consider that until 1984, testosterone — now the paragon of a PED — was not labeled a PED by the American Academy of Sports Medicine. Consider that most PED studies look at ‘weekend warriors’ and not elite world class athletes. And consider that no scientist has studied the effect of any PED on home run production in a double-blind placebo-controlled cross-over pharmacological study. Considering all these points, saying PEDs affect MLB home-runs — or any athletic task — constitutes a classic inductive leap. But a reasonable conclusion in my view.

Gaffney discusses the importance of syngergism in the use of performance enhancing drugs. Bodybuilders have long recognized and exploited the synergism amongst various combinations of anabolic steroids, growth hormone and other peptides, and other performance enhancing drugs and have coined the term “stacking” to describe it. But Gaffney is one of the few doctors I’ve seen that has appreciated the concept of synergy in the context of PEDs in baseball and other sports outside of bodybuilding.

In the complex physiological milieu that constitutes human biology, hormones like HGH do not act alone. Neurotransmitters, hormones, growth factors, and other biochemicals act in concert with a multiplicity of biological variables to produce behavior, performance, emotions, and the other functions that we call life…

Many experts contend that HGH by itself my not increase strength or athletic performance. However, athletes take the drug in combination with anabolic steroids, thyroid hormone, insulin, IGF-1 (insulin-like growth factor), and other ‘stacked’ PEDs. The effects of these drugs appears to be synergistic…

Experts on metabolism and endocrinology suggest that androgenic hormones modulate the response to HGH — ie. a synergistic effect. The response to HGH becomes even more complicated because another hormone IGF-1 may actually be performing much of the cellular dirty-work for HGH.

In 1999, my friend Bryan Haycock wrote a groundbreaking article on the synergism between growth hormone, insulin-like growth factor 1 (IGF-1), insulin, thyroid, and anabolic-androgenic steroids.  The lengthy series offers incredible insight in the synergy of performance enhancing drugs.

In the first installment of this series we discussed the mechanism by which human growth hormone (GH) exerts its anabolic effects in the body. We also discussed the important role of insulin-like growth factor-1 (IGF-1) in the anabolic properties of GH. In part two we discussed the role of androgens in GH secretion and sensitivity in a hypothetical pharmacological regimen aimed at dramatically increasing skeletal muscle growth. Based on research looking at the effects of androgens on GH secretion and IGF-1 sensitivity, it was deduced that the testosterone esters should provide the most potent anabolic stimulus compared to other androgens, especially those that do not aromatize. Now, in the final installment, we shall look at the feasibility of using GH, IGF-1, Insulin, and perhaps tri-iodothyronine (T3) to enhance the anabolic properties of androgens.

Athletes, particularly bodybuilders, will always be far ahead of the scientific community when it comes to experimentation with performance enhancing drugs. Bodybuilders usually are the first to establish trends in the types of anabolic drugs used and the manner in which they are used. The body of knowledge amonst bodybuilders continues to advance through real world trial and error.

There is no prohibition on performance enhancing drugs in bodybuilding which completely eliminates the ethical considerations faced by researchers and physicians and even athletes subjected to doping controls. As a result, anyone who wants to learn about performance enhancing drugs just needs to investigate bodybuilding to learn what is on the leading edge.

According to the World Anti-Doping Code, three substance categories govern the chemistry of cheating—1) It has the potential to enhance or enhances sport performance 2) It represents a potential or actual health risk 3) It is contrary to the spirit of sport—with a score of two-out-of-three being enough to earn a drug a place on the dreaded Prohibited List.

But Kotler points out that the anti-doping code still doesn’t have any clear definition of what exactly “enhances performance.”  Most people think about the physical aspects of performance-enhancing drugs, but the author asserts that the mental aspects of performance are significantly more important than the physical aspects of performance.  Then it would stand to reason that drugs affecting brain chemistry and mental aspects would have the most pronounced effects on performance.

In fact, in the past twenty years, there have been hundreds of studies done by hundreds of researchers linking a positive emotional state to superior athletic performance. Everyone from volleyball players to basketball stars to tennis players to cross country runners have been tested and with few exceptions more happiness equals more winning. And more happiness is now available in pill form.

The author suggests that former Longhorn star Ricky Williams was a bust as a first-round draft pick in 1999 only to have a breakout year in 2002 after he starting using the performance enhancing drug Paxil.

Which brings us to Ricky Williams. In 1999, the New Orleans’ Saints traded eleven draft choices for a chance to select the star University of Texas running back. Williams, if the rumors were to be believed, would revolutionize the position, bringing glory and championships to a team sorely in need. Instead, he merely destroyed the team. How bad was Williams? Three years later he was traded away to Miami for draft picks. In Florida, he finally lived up to the hype. In his first year as a Dolphin, Williams rushed for a league-leading 1,853 yards and made the Pro Bowl. So startling was his turn-around that rumors of drug abuse soon followed. And those rumors were true. Williams was taking drugs. He was strung out on the antidepressant Paxil.

The author does not offer an explanation of what happened to Ricky Williams in 2004 or 2006.

But the question remains. Do SSRI’s and other psychoactive medications have performance enhancing effects? If so, are they measurable? Where do the therapeutic effects end and the performance enhancing effects begin?

Lou Schuler of Male Pattern Fitness has an excellent response to this question:

But the key here is to acknowledge that the only honest way to answer the question of the performance-enhancing effects of human growth hormone is to say, “We just don’t know.”

Schuler is bothered by commentators enter the debate with absolute certainty when the performance enhancing effects of growth hormone are often immeasurable and unknowable due to the lack of scientific evidence.

But in spite of the lack of scientific evidence, Schuler says he is influenced by the anecdotal evidence coming from credible sources such as sports doctors, trainers, strength coaches and pro athletes. He cites a former team physician for the Denver Broncos quoted in a Newsweek article:

Even some sports doctors have given anecdotal testament to the drug’s healing power, claiming that it can cut recovery times—from wear and tear, surgery and sports injuries—in half. “Our observations tell us that it works and that it works well,” says Dr. Richard Hawkins, former team physician for the Denver Broncos. So far, however, solid evidence to support such claims is lacking.

The medical community denied the performance enhancing effects of anabolic steroids for decades as athletes continued to use them in competitive sports. The scientific evidence did not support the anecdotal evidence. Nevertheless, the anecdotal evidence was correct. Sometimes it’s just not possible (from a medical ethics standpoint) to research the various stacks and quantities of performance enhancing drugs used by athletes.

“There’s a great deal of hype and a great deal of testimony, but there isn’t a great deal of evidence,” says [Richard] Hellman [president of the American Association of Clinical Endocrinologists]. The main problem, researchers say, is that they cannot possibly study the effects of HGH in the quantities and combinations that athletes are believed to be using it.

I would tend to believe the sports physicians, trainers and strength coaches who are doing the real world research unrestrained by institutional review boards.

John Lombardo, has granted waivers to players who have failed drug tests but then explained their medical need for testosterone. NFL spokesman Greg Aiello won’t disclose names or reveal how many players have been allowed to pump synthetic hormones into their bodies except to say it’s “a very small number.”

This is the National League Football (NFL) version of the therapeutic use exemption that can be submitted after failing a drug test. An interesting article by Tom Farrey of ESPN the Magazine suggests this is a precedent opening the door to widespread use of hormones in sports like football.

It’s a little-used exemption to the league’s drug policy, but it’s a precedent-setting one: Any player who can show that replacing hormones is critical to his continued health should be allowed to take them.

The demonization of anabolic steroids and performance-enhancing drugs in sports fails when there is a legitimate medical need for treatment. No longer are anabolic steroids and growth hormone categorically bad or dangerous.

Tom Farrey cites recent studies showing that mild concussions can cause brain damage (pituitary dysfunction) resulting in growth hormone and/or testosterone deficiencies.

Players with testicular disease are not the only ones in need. At the base of the brain, encased in a small, bony shell, is a pea-size gland called the pituitary, which secretes hormones that help regulate everything from mood to energy level. For years, the gland had been overlooked in discussions of head trauma. But in the late 1990s, UCLA neurosurgeon Daniel Kelly noticed that many of his head-injury patients suffered from symptoms associated with pituitary failure: depression, fatigue, anxiety, poor concentration. His findings, which he published in 2000, have led to at least eight studies on three continents, which together involved more than 600 subjects. Each study confirmed the link between traumatic brain injury (TBI) and a loss of hormonal function. The most common deficiencies in men were those of growth hormone, which occurred in 15% to 20% of cases, and of testosterone, in 10% to 15%.

Most of the subjects in these studies had suffered a moderate or severe TBI with some bleeding in the head during a car accident, a fall or some other nonsports-related activity. But, Kelly says, “if you look at the literature, there’s a small but definite component of patients with milder head injuries who also lose hormonal function.” One study, in Italy, found pituitary dysfunction in as many as 37.5% of patients with mild TBI, the same level of injury NFL players typically incur when they get dinged.

Another interesting bit of information from this article includes information from World Anti-Doping Association (WADA) about the number of therapeutic use exemptions granted for testosterone and growth hormone.

International sports federations overseen by WADA have granted 15 therapeutic-use exemptions for HGH and 26 for testosterone.

As a society, we’ve already accepted brain damage as an acceptable consequence of playing certain sports. This likely risk in football from concussions doesn’t make the sport unacceptable. Yet, the dangers from anabolic steroids and growth hormone will likely continue to be unacceptable. At the very least, let’s hope that exemptions for the therapeutic use of steroids and other performance enhancing drugs is permitted in sports to preserve the health of affected athlete’s. (Therapeutic use by definition means the benefit outweighs the risk of harm.)

Thanks to Radley Balko for pointing us to this article. He also makes the following comment on the hypocritical concern given to the health of (football) athletes subjected to drug testing:

The league has banned HGH (on very little evidence), allegedly to protect its players from the harm it allegedly does to their health. But the game of football itself is causing debilitating, potentially life-threatening injuries to players, and we think little of it. These injuries are the entirely predictable result of the slobber-knocking hits that make the game so much fun to watch, both live, and from the six different angles in various highlight packages on SportsCenter.

The report also uses statistics to show that Clemens’ performance had unpredictable “ups and downs” or “peaks and valleys” over the course of his career. The report asserts that “straight trend lines in performance” simply do no exist in Major League Baseball.

It suggests that variations in Clemens’ performance were similar to other notable pitchers, including Curt Schilling, who had their best “qualitative performances” later in their career. Schilling has frequently prodded Roger Clemens to come forward and tell the truth (presumably about his steroid use).

The reports also notes that Clemens career after age 40 is not an aberration in Major League Baseball; dozens of Hall of Fame pitchers have pitched well into their 40s.

The clear intent of this report is to refute allegations of steroid use by Roger Clemens in the Mitchell Report. The Roger Clemens report does an excellent job of suggesting that their are many factors that contributed to Roger Clemens late career success. But even as much as the general public and media love single cause theories e.g. steroids were THE reason for Roger Clemens success, I find it hard to believe the public will embrace a competing single cause theory e.g. the split-finger fastball was THE reason for Roger Clemens late career success!