Steroid Nation

The Braun Case: Good clinical practice, steroid (PED) abuse testing, and HIPAA violations

I heard Dan Patrick pontificate on the Ryan Braun situation today. Apparently these sports commentators have Ph.D.s, JDs, and a host of other professional degrees, at least in their own minds.

They also do not need to reveal sources (talk about a slippery slope; what if the source is their dog, ie made up).  Patrick kept referring to "I was told", and "sources".  He made these points:

• Bruan had some huge quantity of synthetic testosterone in his urine.  (actually his T:E as reported was 20:1; 5:1 is usually the cut off for suspicions)
• The issue should not be chain of custody
• Braun should not pursue legal remedies, what what he sue for?  (defamation for a beginning)
• That the chemists are always ahead of the testers (ah he has a Ph.D. in biochemistry now)
• And that big names are enrolling in an MD lead PED program to beat the system (assuredly based on the East German Doping Machine, chuckles)

In medicine laboratory and clinical, the procedure and the processing is vitally important.  If a sample is mishandled, or stored incorrectly, or allowed to warm up (in some cases) the lab values may be in error, and not reliable.  Biologic molecules can decompose, enzymes can metabolize substances, results may be affected.  For experiments, freezers are monitored for constant temperature, labels are clear, and the process is transparent.  If there is a breech, the data is discarded, or should be.

And even then..

Example, I knew of a patient who was told by a physician of standing that he had Hepatitis C, based on high bilirubin.  That was the only value.  I looked at the lab, astonished to hear the conclusions, because nothing else appeared in line with Hep C.  There is a natural variant called Gilbert's Disease where a person walks around with elevated bili.  On retesting that was exactly what the patient manifest - Gilbert's and not Hep C.  So he was given a 'death sentence' based on one lab value.

Thus if there is a breach in protocol, the test is invalid, and it did not happen.  No you cannot reconstruct the results, forget it.  Check out the post on DNA analysis.  Degrdation of lab tests here, here and here.

What is the ideal temp for urin storage?  See below.  The average refergerator is from 35-38C.  And is the household refergerator certified for storage?  BIG OOPS!

But multiple sources said the sample was not shipped for testing as soon as possible, as required by the drug testing policy, and instead was kept in a cool place in the sample collector's home. Sources told ESPN legal analyst Lester Munson that the collector left Braun's sample on a desk in a Tupperware container and left it there for two days.

In retrospect, this was an easy case to arbitrate if the above were true.  Throw out the sample.

So why were Braun's values 'leaked' to the press -- who is going to distort the issue, and hold some kind of kangaroo court on it?  Could this be a HIPAA violation (Health Information Portability Accountability Act)

The Standards for Privacy of Individually Identifiable Health Information (“Privacy Rule”) establishes, for the first time, a set of national standards for the protection of certain health information. The U.S. Department of Health and Human Services (“HHS”) issued the Privacy Rule to implement the requirement of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”).¹ The Privacy Rule standards address the use and disclosure of individuals’ health information—called “protected health information” by organizations subject to the Privacy Rule — called “covered entities,” as well as standards for individuals' privacy rights to understand and control how their health information is used. Within HHS, the Office for Civil Rights (“OCR”) has responsibility for implementing and enforcing the Privacy Rule with respect to voluntary compliance activities and civil money penalties.

A major goal of the Privacy Rule is to assure that individuals’ health information is properly protected while allowing the flow of health information needed to provide and promote high quality health care and to protect the public's health and well being. The Rule strikes a balance that permits important uses of information, while protecting the privacy of people who seek care and healing. Given that the health care marketplace is diverse, the Rule is designed to be flexible and comprehensive to cover the variety of uses and disclosures that need to be addressed.

Clearly there was a breach of confidentiality, unless Bruan gave his consent to releaqse information to ESPN.  The issue is 'covered entitiy'.  Is MLB a 'covered entity' testing employees for drug abuse? Sounds like one law firm may answer positively.

The new Health Insurance Portability and Accountability Act rule on privacy scheduled to go into effect on April 14 may reach as far as the disclosure of information about workplace drug testing and substance abuse management. The Standards for Privacy of Individually Identifiable Health Information, known as the Privacy Rule, generally will prevent "covered entities" from disclosing protected health information to non-covered entities without authorization from the subject of the protected health information. The disclosure requirements may apply to many collection facilities, laboratories, Medical Review Officers and other service providers who analyze and review applicants' and employees' drug and alcohol test results.

"Covered entities" under HIPAA must require employers using their services to provide HIPAA-compliant authorization before releasing drug and alcohol test results (i.e., protected health information) for employees and job applicants. Forms currently being used by employers for this purpose may not meet the requirements of the regulations which identify the key components and specifics for the authorization form. Additionally, the forms must be signed by the employees or applicants. As a practical matter, since HIPAA compliance ultimately falls on the shoulders of the "covered entity," the collection facility, laboratory or Medical Review Officer may have its own authorization form for employers.

In addition to the release of test results, other aspects of an employer's substance abuse policy may require use of a HIPAA-compliant authorization form. For example, when an employee enters into substance abuse rehabilitation, an employer may require progress reports from the substance abuse professional who evaluated and treated the employee. If the substance abuse professional is a "covered entity" under HIPAA, the employer may then be required to have the employee sign a specific HIPAA-compliant authorization form permitting the release of the "personal health information", i.e., the substance abuse professional's records, to the employer.

Baseball has cited HIPAA to assure privacy in medical matters before.

The polyps have bothered Rivera recently. Yankees general manager Brian Cashman, citing HIPAA privacy laws, has declined to talk about the issue because it is not baseball-related.

In fact it is reported MLB requires players to sign a HIPAA statement.  Athough this author doesn't think it is a HIPAA violation, I have been on hospital boards that rang up people for far less a HIPAA violation, This might be a MALIGNANT HIPAA violation.

My conclusions:

• If there was a violation in laboratory protocol THIS LAB RESULT, THIS SAMPLE DID NOT EXIST
• Ryan Bruan's attorney's should be looking at defamation and HIPAA violations.  An HIPAA violations not a laughing matter.

I still say Braun should not expose those abs, which are quite unusual for baseball....  ^^

References:

German documentation of tampered doping urine samples.

From this paper:  Detecting the Administration of EndogenousAnabolic Androgenic Steroids
Christiane Ayotte (name sound familiar, she is head of the Montreal Lab)

2.3 Stability of Urinary Steroid Conjugates
Testosterone glucuronide is known to be stable in urine for at least 1 year when the
specimen is stored below –20C (Venturelli et al. 1995; Robards and Towers 1990),
while one study reported the formation of free testosterone and free dihydrotestosterone
in urine samples kept at 18 and 37C (Kjeld et al. 1977). Testosterone and
epitestosterone conjugates are stable for months in sterile urine kept at 4C and
–20C (Jime´nez et al. 2006), while the addition of a bacteriostatic agent was
required to preserve their integrity in urine samples kept at 4C and 37C for a
week (Saudan et al. 2006). Spiked in sterile urine, authentic standards of androsterone,
etiocholanolone, testosterone, epitestosterone sulfates and glucuronides are
stable even upon incubation at 37C; dehydroepiandrosterone-3b-sulfate, like other
sulfoconjugated steroids, is less stable showing partial deconjugation. Since samples
are not collected under sterile conditions, skin bacteria and intestinal microflora
(staphylococci, enterobacteria, E. coli, etc.) are often present. Delays in
delivering the samples to the laboratory and improper refrigeration during transportation and storage may offer good conditions for microbial growth; the effects on the urinary steroids are easily detectable and consist mainly in the hydrolysis of the steroid conjugates and in oxidoreductive reactions leading to
the abnormal presence of steroids in the free form and the accumulation of 5aand
5b-androstan-3,17-dione, the b-isomers being more rapidly altered. Signs of
microbial degradation should obviously be absent to ensure the accurate measure
of the steroid profile (Ayotte et al. 1996, 1997; Hemmersbach et al. 1997).

Does Apple use steroids to beat 'the law of large numbers'?

Really now, a business writer in the New York Times says Apple's stock price (over 500.00 per share) needs company sales and revenue growth to continue to appreciate.  Even with Apple's incredible sales the 'law of large numbers' says it is harder to grow when the numbers get big. Oooooooo  LMAO!

Here is the rub: Apple is so big, it’s running up against the law of large numbers. Also known as the golden theorem, with a proof attributed to the 17th-century Swiss mathematician Jacob Bernoulli, the law states that a variable will revert to a mean over a large sample of results. In the case of the largest companies, it suggests that high earnings growth and a rapid rise in share price will slow as those companies grow ever large

The 'Law of large numbers' is simply regression toward the mean, and applies to experiments where more and more samples are taken.  The mean of the sample moves closer toward the mean of the population with a larger sample size.  I doubt the original author looked at the New York Stock Exchange in the 1600s.

No no no no no.  It means if the mean height of males in the world is 5-9 (feet and inches), if you take 10 samples (measure 10 men) you might find the mean to be 5-11, but then if you take 100 samples, the mean is 5-10, 1000 samples the mean is 5-9.5 etc. etc.  The larger the number of samples the closer your experiment becomes to measuring the true mean (what ever that is).

This is not applicable to the stock market, or to business sales, unless you are sampling the satisfaction of the world with the IPhone on a 10 point scale.  ROFL!

The TImes (the column is called 'Common Sense', of which this isn't) does it again:

There may be sobering reasons for that. Other companies that have reached the top appear to have been felled by Bernoulli’s law. Cisco Systems held the top position and hit a market capitalization of $557 billion — larger than Apple’s — in March 2000, at the peak of the technology bubble. Its market capitalization today is about $100 billion, and shares are down nearly 80 percent since March 2000. In contrast with Apple, Cisco’s market value and sky-high 120 P/E ratio were inflated by investor euphoria rather than actual results. But other titleholders have met a similarly disappointing fate, although far less drastic.

Cisco was felled by Bernoulli's law?  Oh no, those rascally statistical principles are killing businesses!  Corporate felonies by heinous statisticians!

I 'spose on first blush it makes sense to think once a company is large, it becomes harder to expand, or is it?  Perhaps growth can be exponential rather than numerical?

Will China's population fall to the 'law of large numbers'?  Will there soon be only 300 million Chinese rather than 1.3 billion because of that rat Bernoulli?

Apple sold 37 million Iphones and 15 million IPads last quarter, an increase of roughly 70% measured year to year (revenue).  How many more IPhones can they sell?

There are 7 billion people in the world.  That's alot of customers for IPhones.  Not to mention to damn things quit working or go through the laundry (looking at you LIz).

There are even people who buy a couple computers or tablets (blush) per.

But, alas, even these sales are like steroids -- you get gyne.  Likely the Law of Large Numbers will say that sales to individuals will revert to the mean.  One tablet per human.  Only a potential of 8 billion tablets.

I weep for Apple...lose the steroids Cupertino!

 

 

Ryan Braun challenges MLB's drug testing system, wins steroids appeal

Ryan Braun who reportedly showed evidence of anabolic steroids during an MLB steroids screen, defeated the league's testing on appeals citing an unsecured chain of custody.  There were plenty of missteps along the way no doubt.

1.  Results of the positive test leaked out to the public from ESPN.  Most accounts in the press accept leaked information, however why are reporters (and ESPN) held to some kind of ethical standards.  Can they leak any confidential medical information?   Ring them up on HIPPAA violations.

2.  Apparently the chain of custody for steroid samples was not well planned out.  Although the T:E ration was 20 in Braun's sample, the arbitrator ruled that chain of custody and the testing procedure was not 'state of the art'. (ESPN)

In his appeal, Braun didn't argue evidence of tampering and didn't dispute the science, but argued protocol had not been followed. Multiple sources confirmed to ESPN investigative reporters Mark Fainaru-Wada and T.J. Quinn that Braun questioned the chain of custody and collection procedure.

MLB officials argued that there was no question about the chain of custody or the integrity of the sample, and that Braun's representatives did not argue that the test itself was faulty.

But multiple sources said the sample was not shipped for testing as soon as possible, as required by the drug testing policy, and instead was kept in a cool place in the sample collector's home.

I am not a lawyer, but defense attorneys will question procedure integrity from the outset.  And why not, if the consequences are severe, MLB should maintain a tight, professional, well-supervised chain of custody and maintain 'good clinical practice' for these biological samples.  There can be a ton of errors if good clinical secure procedure is violated.

Braun is claiming innocence, which is true in the strictly 'eligilbe to play' sense.  He beat the positive test on procedural grounds.  That means the needle moves more toward 'no evidence of anabolic steroids' than 'evidence of  anabolic steroids'.

You see, nothing in medicine or the laboratory is absolute, unless it is birth or death, and even then mistakes can be made.  It is 'preponderance of the evidence' (apologies to you with obsessive-compulsive disorder).

Braun said this:

"We provided complete cooperation throughout, despite the highly unusual circumstances. I have been an open book, willing to share details from every aspect of my life as part of this investigation, because I have nothing to hide. I have passed over 25 drug tests in my career, including at least three in the past year."

Passing 25 tests is unimpressive.  The logic is like "But officer your speed gun is wrong because I have driven this road 400 times and never once was clocked at 100 mph".  Well, yeah, but now you were.  Except the officer jiggled the speed gun, so the results are not considered 'good clinical practice'.

It is said MLB may appeal in federal court.  Forget it.  Don't waste time on juice under the bridge.  Tighten up the procedure and the collection protocol.  If a guy juices once, it is unlikely he can go cold turkey forever.  Sooner or later....

Other takes:

Jeff Bradley talks about Ken Caminti and Jose Canseco, and A-Rod.  What's the point?  Athletes will cheat for advantage.  Monitor them with legally sound good clinical practices.

As for Braun, nothing  about last year pops out as particularly unusual.  .332, 33, 111 are not career highs.  He was a 29 year-old 6-1, 210 pound slugger.  He doesn't really look like a 'roid abuser.  There is no Barry Bonds 175 pound lanky dude to 250 pound middle linebacker with huge-neck-muscles transformation.  If he keeps clean for a couple years, the memory will fade.

Does this mean that everyone else can challenge the system including Manny...?

Juicing in Japanese wrestling: Wrestler took 'girlfriends' tamoxifen

Japanese freestyle wrestler Takahiro Shimonaka tested positive for tamoxifen, a 'masking agent for anabolic steroids, as well as a counter drug for gyne.  His excuse is classic:

TOKYO (AP) — Japanese men's freestyle wrestler Takahiro Shimonaka has been suspended two years for a doping violation.

The Japan Anti-Doping Agency says traces of Tamoxifen were detected in Shimonaka. Athletes commonly use the drug to counter the side effects of steroids.

Kyodo news agency reported that Shimonaka told JADA he mistakenly took Tamoxifen, which belonged to a woman he lives with.

Shimonaka tested positive after Japan's national championships in December, when he won the silver medal in the men's 211-pound division.

Should be an an easy story to check out, simple look at her medical records.  The drug is anti-estrogen, used for cancer treatment, and in younger women infertility.

If you do the 'roids face up to the consequences and don't hide behind your girlfriend.  They should ban the guy for an unimaginative and nasty alibi.

Should Barry Bonds be immortalized outside of ATT Park? Holding a syringe?

From the Sacramento Bee, comes this item on the possibility of a Barry Bond statute outside of AT&T Park:

It's safe to say Roger Clemens won't have a statue of his likeness outside Fenway Park.

Not just because of his link to steroids and legal troubles, but because Clemens went on to win two championships with the New York Yankees. In Boston, that's unforgivable.

A statue of Sammy Sosa outside Wrigley Field? Not going to happen.

A statue of Mark McGwire outside Busch Stadium? We're not here to talk about the past, sorry.

A statue of Barry Bonds outside AT&T Park? Hold the phone a second.

Does Bonds deserve to be immortalized with a statue of his likeness – his arms raised as he watches home run No. 756 sail over the center-field wall? Should he join other Giants greats – Willie Mays, Willie McCovey, Juan Marichal and Orlando Cepeda – who have statues?

Some Giants fans will say that while they cheered for Bonds before his arms, chest and head made him look like a cartoonish figure, he disgraced the game by using performance-enhancing drugs.

Others will say none of that matters; he provided them with memories that will last a lifetime. Besides, how can the Giants not honor a Bay Area son who is baseball's all-time home run king (wink, wink)?

Though the Giants benefited from Bonds' home run era, they are in no hurry to decide on a statue, and they will continue to keep a polite distance from their former star for now.

The Giants most likely will wait to see if Bonds is elected into the Hall of Fame in his first ballot later this year. If he is, it's just a matter of time before a statue is unveiled.

Why not put a bronze Bonds outside the park?  Maybe a statue of Bonds holding a syringe?  Or Bonds with gynecomastia from 'roiding?  How would you pose Bods to immortalize the career home-run leader?

Big Mac confirms Big Stack: Mark McGwire admits to anabolic steroid use

Apparently trying to avoid a multitude of controversy, The new Cardinal batting coach -- former slugger Mark McGwire -- has released a statement to the press admitting his anabolic PED use.  All is forgiven, welcome home to mother St Louis Mark McGwire.

Mark McGwire finally came clean Monday, admitting he used steroids when he broke baseball's home run record in 1998.

McGwire said in a statement sent to The Associated Press on Monday that he used steroids on and off for nearly a decade.`I wish I had never touched steroids,'' McGwire said in a statement.

``It was foolish and it was a mistake. I truly apologize. Looking back, I wish I had never played during the steroid era.''

McGwire also used human growth hormone, a person close to McGwire said, speaking on condition of anonymity because McGwire didn't include that detail in his statement.

McGwire's decision to admit using steroids was prompted by his decision to become hitting coach of the St. Louis Cardinals, his final big league team. Tony La Russa, McGwire's manager in Oakland and St. Louis, has been among McGwire's biggest supporters and thinks returning to the field can restore the former slugger's reputation.

``I never knew when, but I always knew this day would come,'' McGwire said. ``It's time for me to talk about the past and to confirm what people have suspected.'' He became the second major baseball star in less than a year to admit using illegal steroids, following the New York Yankees' Alex Rodriguez last February.

American loves a reformed (fill in the blank).  For example Elliott Spitzer is working his way up the business world again, and Martha Stewart is decorating with renewed aplomb.

Perhaps Bernie Madoff could come completely clean about cheating his clients out of billions of dollars then be allowed to serve as SEC commissioner.

While it is true McGwire deserves a commendation for admitting past steroid sins, it is also true that his baseball statistics are simply a fraud.  Any Big Mac career total of offensive stats are frankly a sham.

If a scientist who cheated on cancer research admits that his research was actually fraudulent, would those publications continue to  be allowed as a reference?  (now that depends on his standing and power in the scientific community)

McGwire cheated his sport (and not talking of the merits of PEDs here) and thus should probably be banned as a participant in the sport in the future.  He is a cheat, and now an admitted one.  That may seen harsh, but if baseball has integrity, then cheaters should not  be trusted to participate in any future MLB activities.

Any allowance of an admitted steroid cheat like McGwire means MLB tells us that rules, and that integrity are simply not valued in their world. 

Sports fraud laws should be enacted to punish the cheaters; otherwise a fan should believe nothing about the athletes on the field other that they will destroy the rules as the PED fraud fest continues on.

Sorry, Mark McGwire, but you used steroids to cheat your fellow athletes, an action not all of the MLB conspired in.  You cannot wish away the facts, but you can continue to bask in the stats you put up by cheating.

Interest turns to Tiger Woods PED use: Links to Canadian doping doctor noted

Anyone who knows PEDs knows one of the side effects of anabolic steroid use is a heightened libido.  Testosterone is the fuel of the sex drive in males and females.  The East German Doping machine produced some very hyper-sexual swimmers.   And when one thinks of recent athletes who appear to have a huge libido...one has to consider the use of an anabolic steroids that may induce such a hyperactive drive.

The athlete clearly in the public eye these days is disgraced pro golfer Tiger Woods.  Today named the athlete of the decade (apparently using exploits only on the golf course as a criterion), Woods appears to sport a prodigious libido.

A Canadian doctor called a 'pioneer' appears to be the go to man in several athletes with questionable physical feats (The New York Times)

A Canadian doctor who has treated many N.F.L. players as well as Olympic medalists like Donovan Bailey and the world’s top golfer, Tiger Woods, is under criminal investigation in the United States. He is suspected of providing athletes with performance-enhancing drugs, according to several people who have been briefed on the investigation.

The F.B.I. investigation of Dr. Anthony Galea, a sports medicine specialist who has treated hundreds of professional athletes across many sports, follows his arrest on Oct. 15 in Toronto by the Canadian police. Human growth hormone and Actovegin, a drug extracted from calf’s blood, were found in his medical bag at the United States-Canada border in late September. Using, selling or importing Actovegin is illegal in the United States.

Dr. Galea is also being investigated by the Royal Canadian Mounted Police for smuggling, advertising and selling unapproved drugs as well as criminal conspiracy. He is tentatively scheduled to appear in a Canadian courtroom on Friday.

Activegin, a calf blood derivative, has been known as a blood doping agent among cyclists.  Gary Wadler says this about the substances activity:

In research studies, Actovegin has been shown to exert insulin-like activity, such as stimulating the transport of glucose in the body, as well as glucose oxidation.

That could be good news for athletes, Wadler says. "Athletes are always looking to get more oxygen to working muscles."

''The idea here was to deliver it therapeutically, to improve the transport and use of oxygen and sugar," he says...

(to the Times:)

The United States Anti-Doping Agency has developed “intelligence” that athletes are using Actovegin to attempt to improve performance, according to a person with knowledge of the matter. Usada asked the World Anti-Doping Agency to ban Actovegin this year but it declined.

Woods consulted with Galea following his knee surgury in 2008.  Galea, who of course claims he is spotless *any professional ever claim to be corrupt?) has a checkered history:

Dr. Galea has developed a reputation among elite athletes for accelerating recovery after surgery or for helping them avoid surgery altogether by using a blood-spinning technique known as platelet-rich plasma therapy, as well as other pioneering procedures, on knees, elbows and Achilles’ tendons.

Although he said he prescribed human growth hormone to some patients in his general practice and had used it himself for 10 years, Dr. Galea, 50, said in an interview that he had never treated professional athletes with H.G.H.

Dr. Galea said Mr. Woods was referred to him by the golfer’s agents at Cleveland-based International Management Group, who were alarmed at the slow pace of Mr. Woods’s rehabilitation after knee surgery in June 2008. The doctor said he flew to Orlando, Fla., at least four times to give Mr. Woods the platelet therapy at his home in Windermere, Fla., in February and March of this year. When asked for comment about Mr. Woods’s involvement with Dr. Galea, Mark Steinberg, of I.M.G., responded in an e-mail message: “I would really ask that you guys don’t write this? If Tiger is NOT implicated, and won’t be, let’s please give the kid a break.”

Dr. Galea’s legal problems began in late September when his assistant was stopped entering the United States from Canada. Her car was searched by border-crossing guards and authorities found Dr. Galea’s medical bag, which contained four drugs, including human growth hormone, Dr. Galea said. “It was for my own use,” he said.

Galea was raided in Canada:

As part of his practice, Dr. Galea said he prescribed human growth hormone to patients 40 and over to improve their stamina when working out and to combat fatigue, among other health benefits.

“The authorities here and elsewhere have it wrong,” Mr. Greenspan said. “They don’t understand the medical aspects.”

Prescribing human growth hormone is legal in Canada but approved in the United States only for a few specific uses that do not include hastening recovery from surgery or injury. In the world of sports, under World Anti-Doping Association guidelines, H.G.H. is banned though not widely tested for because it requires a blood test. The N.F.L., the N.H.L., the N.B.A. and Major League Baseball do not test for H.G.H.

No, the police may not know unsubstantiated claim, doc, but some professionals do...ethical ones.

However, athletes will do anything they can to obtain an dedge in competition, ethical or not, proved or not.  And Galea apparently has a database of interesting athletes including the 2008 controversial swimmer Dana Torres, who defies gravity with her performances.

“Ten years from now, they are going to say, wow, this guy was a pioneer,” Dr. Lindsay said in a recent phone interview. “That’s the unfortunate thing.”

Dr. Galea blames his current legal problems on his success rate.

“All these athletes come see me in Canada cause I fix them, and I think people just assume that I’m giving them stuff,” he said. “They don’t have to come to me to get H.G.H. and steroids. You can walk into your local gym in New York and get H.G.H.”

The N.F.L. quarterback Chris Simms and wide receiver Javon Walker swear by him. In March, Dr. Galea arranged for Mr. Walker to have cartilage-replacement surgery on his knee in Jerusalem because the procedure is not approved in the United States or Canada. Mr. Walker said the recovery time was half what it would have been if he had had the procedure doctors recommended in the United States.

“He’s a person who just wants to help and heal,” Walker said. “And the world is going to soon know about him.”

The Olympic swimmer Dara Torres said she sought out Dr. Galea to help diagnose the cause of continuing pain in her knee earlier this year. “He found a tear in my quad tendon that was undiagnosed,” Torres said in an e-mail message. “Excluding draining my knee, he has never treated me, but I did see his chiropractor who did soft-tissue work on my leg. That was the extent of my visit with him.”

The Times recounts Galea's treatment of Woods this way:

Dr. Lindsay said he led Mr. Woods’s rehabilitation team after the golfer’s June 2008 surgery to repair his anterior cruciate ligament. In addition to Dr. Lindsay, who is best known for overseeing Alex Rodriguez’s rehabilitation from hip surgery last spring, the Woods team included Dr. Galea and a Vermont-based strength coach named Bill Knowles.

Dr. Lindsay said he worked with Mr. Woods at his home throughout his eight-month rehabilitation. The work included strength training, conditioning and exercises in a swimming pool, Dr. Lindsay said.

In February, discouraged by the lack of progress, Dr. Lindsay asked Dr. Galea to look at Mr. Woods, who was suffering from patellar tendinitis and had scarring in the muscle. “It’s common after the A.C.L. to have tendinitis,” Dr. Lindsay said. “And the P.R.P. helped.”

Dr. Galea said he treated Mr. Woods in his home four or five times with a borrowed centrifuge from an Orlando doctor. Each time, he said he drew blood from Woods, spun it to increase the platelets’ count and then injected a small amount directly into Mr. Woods’s left knee.

Two days after the first treatment, Woods texted him, Dr. Galea said: “He said he couldn’t believe how good he feels. He’d joke and say, ‘I can jump up on the kitchen table,’ and I said, ‘Please don’t.’ ”

Dr. Galea said that Mr. Woods stayed in touch, texting him after the British Open in July that his left knee had begun bothering him again. Dr. Galea said he flew to Orlando in early August and gave Mr. Woods P.R.P. therapy for a final time.

Very interesting, which might be an issue with those who regulate PEDs.  Those with money and connections can obtain these 'treatments'.

So what about Woods' recent troubles in term of 'drive' and we don't mean off the tee.  Look at Woods before and after photos.  Think of the side effects of testosterone and anabolic steroids.  Then consider an athlete who has established ties with a physician who says he pushes HGH and other PED treatments.

It's like hitting over 750 home runs...hitting long off the tee, with the subsequent side effects.

More injections upcoming

 
 
After an extended absence, we return to needle steroid users in sports and entertainment.  We were crushed by responsibilities at work, were geniuses decided to install new clinical software that has multiplied the time spent documenting clinical information, as well royally messing things up.  It was an 'Epic' decision (some of you know what we are talking about there).

We need to remind ourselves how things work on this blog; spring training all over again.

We see A-Roid is doing well int he playoffs.  Why does no announcer present the problems that A-Rod gives to the ethics of fair competition in this MLB playoff series; then again considering the blown calls in the Yankee's favor t hat may be the least of the issues in the ALCS.

Danica Patrick gets caught in typical thinking" "It aint cheating unless you get caught"

How many times have we heard it?  It ain't a foul unless the ref blows the whistle.  It ain't cheating unless you get caught.  It ain't illegal unless you get arrested.  Danica Patrick knows it.

Not to advocate a world of obsessive rules, bureaucratic entanglements, and snitches, but really can we ever expect to make a dent (to coin a phrase) in cheating and drug-cheating if this attitude permeates the world?  Don't hold your breath waiting for change.  To the Seattle Times:

The CEO of U.S. Anti-Doping Agency isn't amused by driver's comment in Sports Illustrated: IndyCar driver Danica Patrick insists she was joking when she said using performance-enhancing drugs would only be cheating if she got caught.

Not so funny, said the leader of the U.S. Anti-Doping Agency.

Travis Tygart, USADA chief executive officer, said Patrick's comments, printed in Sports Illustrated, were "totally irresponsible."

"In one interview, she undercut what millions of parents try their best to teach their kids every day in this country, that winners never cheat and cheaters never win," Tygart said Monday.

In an interview with Dan Patrick published in Sports Illustrated, Danica Patrick was asked if she could take a performance-enhancing drug and not get caught, would she do it if it allowed her to win the Indianapolis 500.

"Well, then it's not cheating, is it? If nobody finds out?" she said.

Dan Patrick responded: "So you would do it?"

Danica's answer: "Yeah, it would be like finding a gray area. In motor sports, we work in the gray areas a lot. You're trying to find where the holes are in the rule book."

Danica Patrick, 27, later said she was joking and apologized in the event her comments came across differently.

"It was a bad joke," she said in an interview that appeared in USA Today.

Right, Danica, a joke.  Like we believe that.

Note this Patrick add.

Dwain Chambers still hanging with Victor Conte, despite BALCO history

In the 'They never learn' category', it appears ex-BALCO client and current comeback sprinter Dwain Chambers continues use ex-BALCO boss Victor Conte as his go-to expert in performance enhancement.

You would think Chambers, now trying to work his way back into track, would refrain from association with the man who supplied him with illegal steroids and PEDs.  Apparently not the way he thinks.

Athletic's world governing body has admitted it is shocked that Dwain Chambers has reunited with controversial coach Victor Conte.

Conte spent four months in jail for his role in the Balco Laboratory scandal that rocked athletics.

Chambers tested positive for the banned substance THG in 2003 and served a two-year ban.

But the sprinter is using a hi-tech breathing device to boost his oxygen capacity under the supervision of Conte.

The IAAF said the disgraced sprinter, who won the 60 metres title in the European Indoor Championships last week, should distance himself from Conte.

"We're very surprised that he's still associating with people like Mr Conte," an IAAF statement said.

"And if he's looking forward to a career and claiming that he's doing that in all legality, it's probably wise to disassociate yourself with people with a reputation for being involved in doping in sport."

The device simulates high altitute.  And Victor Conte simulates a coach

Oxyhealth -- maker of hyperbaric oxygen chambers -- sues Japanese Antidoping Agency

An American hyperbaric chamber manufacturer -- Oxyhealth -- initiated legal action against the Japan Anti-Doping Agency (JADA) for outlawing their hyperbaric chamber.

The hyperbaric chamber drives more oxygen into the blood stream.  There is no consensus whether this treatment is effective in athletic training enhancement.  It seems odd that the company, which does not market the device as a performance enhancing device in sport, would care about the doping implications.  One would think the company would focus on the medical uses of the chambers, rather than unproven sports performance enhancement.

In fact looking at OxyHealth's web site is is difficult to determine how exactly the chamber could be useful.  Like many other gadgets, people are always trying them to find some performance edge.

The story is found at the Mainichi Daily News:

An American company that manufactures and sells high-pressure oxygen chambers, used by athletes to recover from fatigue, is poised to file a damages suit against the Japan Anti-Doping Agency (JADA) early next month for causing a sharp decline in sales, it emerged on Friday.

According to the Japanese arm of American company OxyHealth, sales of its portable hyperbaric chambers have dropped dramatically since the JADA in June expressed its view that use of the capsules should be avoided because they might artificially enhance the intake, carrying and supply of oxygen, which could be considered as doping.

OxyHealth, whose lost earnings from the previous year totaled nearly 1 billion yen, is currently bringing judicial proceedings against the JADA, its Japanese arm said.

JADA appeared to be acting as if the Oxyhealth chamber were a doping agent.  The theory goes that the hyperbaric chamber stimulates an atmosphere akin to high altitude training, and thus would increase hemoglobin and oxygen carrying capacity.  This would be artificial doping.  However the World Anti-Doping Agency (WADA) maintains there is no evidence that a hyperbaric chamber is effective to enhance sports training.

After the JADA recommendation in June, Japanese athletes did not use them during the Beijing Olympics, and schools belonging to the Japan High School Baseball Federation also refrained from their use.

The advisory stands despite a statement from the World Anti-Doping Agency (WADA) in November, which said they should be permitted since there is no evidence they enhance athlete performance.

The International Healthy Baric Association Japan, an industry association based in Tokyo's Bunkyo-ku, asked the JADA to retract the advisory. However, it refused on the grounds that the WADA didn't officially decide to permit the use of the capsules, and that there will be no change in its rules for the next year.

Hyperbaric chambers are used by many famous athletes, including English soccer superstar David Beckham during the FIFA World Cup in 2002.

As opposed to an oxygen tent, or to a reduced oxygen tent, a hyperbaric chamber would increase barometric pressure on the person to theoretically increase oxygen in the blood.  This would be useful for the treatment of CO2 poisoning; however no one apparently has demonstrated the usefulness for sports training. 

We include two studies on hyperbaric chambers in sports training with differing conclusions as to benefit, although the parameters are different.

Lab delay accounts for slow processing of USA swimmer Jessica Hardy's doping Olympic disqualification

A delayed delivery of the bad news containing Jessica Hardy's positive doping test prevented any insertion of a substitute in the US lineup for the Beijing Olympics, the LA Times says today.  (first in the Seattle Post).

The positive drug test of U.S. swimmer Jessica Hardy was delayed, officials said Friday, a miscue that probably deprived the team of a replacement.

The U.S. Anti-Doping Agency clarified why authorities, despite an expedited request, didn't notify Hardy of a July 4 positive test at UCLA for clenbuterol until July 21, the deadline for naming a replacement. That delay kept USA Swimming from replacing Hardy on its Olympic roster, spots that could have been filled by Tara Kirk and Lara Jackson.

Had the USA determined that Hardy was ineligible quickly, the team could have subbed the 3rd place swimmer -- Kirk -- in here slot.  However, the delay ruined the opportunity to send a substitute.

The UCLA lab incorrectly logged the sample, failing to mark it expedited as requested, and the result later sat, unnoticed, in USADA's offices the weekend before July 21, Ron Judd of the Seattle Times reported Friday. The lab's director, Dr. Anthony Butch, acknowledged that in an interview with the Seattle Times, saying: "We dropped the ball, and we missed it. We clearly made the mistake."

A prepared statement Friday from USADA said, "Both USADA and USA Swimming anticipated that the requested expedited reporting could be fulfilled by the [UCLA] laboratory, understanding that it requires a delicate balance of good thorough science with the need to have results quickly to name teams.

"While under the circumstances it is regrettable that the laboratory was unable to meet the expedited time frame requested by USADA for every sample submitted, the vast majority of the samples from all Olympic Trials were analyzed within the schedule requested."

Gee whiz, a fake phallus: The whizzinator rears it's ugly head again

The Whizzinator, that pretend phallus that squirts out bogus urine to fool doping tests has risen from the dead (or the flaccid).  The Times Online wonders if that's a fake phallus in the testing stall, or is the athlete just happy to be tested:

Meanwhile, British officials are taking action to prevent athletes fooling dope testers by using false penises when giving urine samples. The penises, and untainted urine, are widely available on the internet.

Doping control officers have been given strict guidelines that athletes must be observed and their bodies visible from the stomach to the knees when they produce urine specimens.

Russell Langley, of UK Sport, said: “This is necessary because there have been cases in other countries where sportsmen have tried to manipulate the sample provision.”

The fake phallus came first, later upstaged by Viagra rising.  However the penis is back:

One early case occurred in the 1978 Tour de France when the race leader, Michel Pollentier of Belgium, was found to have a rubber tube containing untainted urine hidden in his armpit.

The problem has grown because of the sophisticated equipment available online. One site advertises a kit that includes a “very realistic prosthetic penis” and dried urine.

An athlete may purchase the Whiz in any number of appropriate skin tones.  Here is a testamonial:

THANK THE GOOD LORD FOR THE WHIZZINATOR!

THIS THING IS AWSOME! IT`S BY FAR THE ULTIMATE TOOL FOR LIVING IN TODAYS WARPPED SOCIETY.ITS THE BEST, AN SO EASY TO USE!!!!!!! THANK YOU GUYS SO

Yes, thank god for a product that allows a person to cheat.

Daily Steroid Dose

1. Trying to determine what is doping and what is artificial and what is not in the Olympics (San Jose Mercury-News)

2. Kelley Blair pumped himself up as source of steroids for Clemens, Pettitte, and Bagwell (NY Daily News)

3. Prison guard sold durgs (?steroids) to inmates. (Foster's Daily)

Daily Steroid Dose

1, Oscar Pistorius  gets a leg up on IAAF; cleared to run in Olympics. (ESPN)

2. Trevor Graham trial to start on Monday (Reuters)

3.  Hunky Brazilian swimmer Gusmao given 2 years ban for doping. (The Guardian)

4.  Hilton Head island woman receives package of unordered steroids.  Will enter Ms Olympia contest soon.  (Islandpacket)

Daily Steroid Briefs

1. Roger Clemens issues apologies.  Too late for all the Rocket explosions? (ESPN)

2.  Link to Travis Hafner post removed

3.  The ethics of augmentation technologies in sports (IEET)

4.  America's Shalane Fleming approaching dope-tainted world womens 10,000m mark (AFP)

Daily Steroid Briefing

1. Is 'technological doping' ruining sports and causing injuries?  (The Herald)

2.  The Toronto Argonauts go with steroids and GHB: Sign David Boston (CBC Sports)

3.  Dope?  Here is something about all the dopes in America: American eduction on the rocks (NY Times)

4.  The ageless controversy over anti-aging clinics (Meso-RX)

Daily steroid briefing

1. The LA Times reports on performance enhancing swim suits.
2.  Author turned his 'roid rage into Esquire read.
3.  Short fiction story about a father pumping kid with the juice.
4.  CNN reports on MLB old timers views on steroids.

Could it be this easy? New mouthguard's electrical stimulation produces results equal to steroids and HGH

Oh man.  You are telling us that Barry Bonds didn't need BALCO?  That Roger Clemens should have bypassed Brian McNamee on the way to Cooperstown?  That a new mouth guard on the market will produce performance-enhancing results equal to HGH or steroids?  That's going to be hard to chew on.

This is what the Wizard of Odds says.  As the best college football site on the Internet, those boys know what they are talking about.

The Pure Power Mouthguard, manufactured by Pure Power Athletics Group, uses bilateral electrical stimulation to relax face muscles, allowing the rest of the body to work more effectively.

Ninety percent of people don't align their jaws properly, according to the manufacturer's site, which causes facial muscles to be "unhappy." The company said there was a physical connection between these muscles and body posture, which in turn has an impact on athletic performance.

Forget sports.  How about the ACT/SATs?  L-SATs?  How about Hilary Clinton on the campaign trail.  Is there enough time to get her jaws aligned properly for big wins in Texas and Ohio tomorrow?

Maybe that won't happen.  But the claim of lower jaw alignment producing improved balance and increased upper body strength?  Come on this is 2008.  Perhaps proper lower jaw alignment will decrease headaches, or allow you to chew properly.  But increased upper body strength?  Bite us.

More here:

University athletes will be trying out a new mouth guard that safely reproduces some of the effects of steroids and the human growth hormone, said Dr. Michael Bixby, a Rutgers College alumnus.

He said players from the Rutgers football and basketball teams would likely test the product as part of an intense University study that aims to determine the guard's reported benefits, although Jason Baum, assistant athletic director for football media and public relations, said he was not aware of any such plans at press time.

Right about now Rutgers should be looking at their graduation rolls.  Someone slipped by without taking a science course.

Of course mouthguards are important to prevent dental and facial injuries.  TMJ is a problem in sports.  But these claims of enhanced performance?  Let's hope no one bites on that claim.

There has been a significant increase in the number of individuals participating in contact sports. As a result, every effort must be made to provide the athletes with protection against mouth injuries. In this review the use, construction and benefits of mouthguards in all sports has been described. There is unanimous opinion attesting to the benefits of such protective devices and in those sports where the athlete is required to wear a mouth guard, a dramatic decrease in the number and severity of injuries has been reported...

Studies on performance enhancement as a result of mandibular orthopaedic repositioning appliances have also been reviewed. Long term studies are required to assess the claims of ergogenic enhancement utilising proper study design. Current evidence exists relating to the effects of psychological phenomena on athletic performance, and it is believed the placebo effect contributes to the findings of performance improvement.

New evidence implanted in Congress may bust Clemens

The New York Daily News says that Congress investigators found new evidence that Roger Clemens attended Jose Canseco's Florida party: there occurred a battle of the breast implants.  (also see Congress to turn over Clemens to Justice)

Congress is believed to have received new evidence over the past 10 days that may further undermine Roger Clemens' sworn testimony that he did not attend a suddenly notorious 1998 party at Jose Canseco's South Florida home.

The Daily News has learned that in the days since the Feb. 13 public hearing on steroids in baseball, another major leaguer has informed congressional investigators that Clemens often joked in the clubhouse about a memorable account of the party - a scene in which Debbie Clemens and Canseco's ex-wife Jessica compared the results of their surgical breast enhancements.

So why the big deal about a silly Canseco party?  Here's why:

The 1998 Canseco party is crucial because it was there that Clemens allegedly talked about steroids - and may have even used them for the first time, McNamee has said.

"I think he got it at Canseco's house," McNamee said in a secretly recorded Dec. 12 conversation at his home with private investigators working for Clemens' lawyer Rusty Hardin. "As far as the government and Mitchell, they know that he got the Winstrol at a party; and that's when he did Winstrol."

This story has morphed into a Kafka novel.  The entire McNamee-Clemens feud.  Debbie Clemens's HGH and inplants.  It's nuts.

"I mean, they talked - no disrespect, but they talked about how great Jose's wife's augmentation job was to Debbie and showed her," McNamee said. "And then Debbie showed her her augmentation job."

Where could these revelations lead?  First, would be a Congressional referral to the Justice Dept for a perjury investigation.  And second, IRS agent Jeff Novitsky -- the lead hammer of the BALCO probe -- appears to be taking an interest in Clemens.  Clemens's attorneys seem to be backing down on some counts:

Hardin backed off Clemens' denials about being at the party after the Daily News reported last week about the existence of a photo that may link Clemens to the party. The photo is owned by a young man who attended the party when he was 11 years old and took photos of his baseball heroes, including Clemens.

That photo is believed to be among the pieces of evidence (along with blood-stained medical refuse) being reviewed by IRS special agent Jeff Novitzky and prosecutor Matthew Parrella, who have much broader investigative power than the committee's attorneys did.

All this should 'augment' evidence against Clemens.

 

Double amputee athlete would like shot at the Olympics

From the BBC comes a story of a track athlete, a double leg amputee, who would love to compete at the Olympic level; however Olympic rules prohibit his participation.  The Olympic committee considers the prosthetic devices he wears to run, called 'Cheetahs', performance enhancing.

Oscar Pistorius is the runner's name;  he currently holds 3 Paralympic world records in the 100, 200, and 400.  Using the double prosthesis, Pistorius is known as 'Blade Runner':

His coach, Ampie Louw, says Oscar is "a natural champion - born that way".

The 20-year-old South African is one of a handful of runners around the globe who could make the Olympic qualifying time. He is less than a second away.

But Oscar's Olympic bid is like no other - he is a double amputee.

How good is he?  His 100, 200, and 400 times are not equal to winning times at the 2004 Olympics.  However, he recently finished second in the South African National Championships.  That was second against non-amputee athletes. (see comparison chart to the right for Pistorius' times)

400m times (in secs): 46.56 - Pistorius world record 47.8 - 1928 Olympic gold 44.00 - 2004 Olympic gold 200m times: 21.58 - Pistorius world record 22.0 - 1920 Olympic gold 19.79 - 2004 Olympic gold 100m times: 10.91 - Pistorius world record 11.2 - 1906 Olympic gold 9.85 - 2004 Olympic gold

The blades are made in Iceland:

The manufacturers, Ossur, say the blades are "passive devices", which lag way behind what biological legs can do.

They insist the Cheetahs are not performance-enhancing, but simply give amputee athletes a fighting chance.

However the IAAF rules look skeptically on artificial devices in athletes:

Senior officials have "suspicions" about his performance on the Cheetahs.  Oscar says his critics are only looking at the advantages of the blades - "if there are any" - and not the disadvantages.  "There's never been a disabled athlete running in the Olympics," he says.  There's a fear of change."

Sports by Brooks (scroll down) researched this issue more.  There were suspicions at one point, that Psitorious used longer prosthesis to his advantage.