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).

Gene therapy -- myostatin -- Discovered once again

Ongoing research into gene therapies that purport to enhance muscular development, have concerned anti-doping authorities for years.  Such therapies, if successful, would radically alter the playing field of sport.  The haves (athletes who could afford the procedure, or who hijack it) would dominate the games over the half-nots.  Nonetheless medical researchers almost blindly push ahead (or push ahead for economic gain). 

Discover magazine jumps on the controversy with this post.  One commenter laments that holding up gene therapy because of doping cheats would slow down medical progress (although it never hurts to allow the ethics to catch up with the science).

A gene therapy treatment intended to reverse muscle weakness appears to restore muscle mass in monkeys, raising hopes that doctors may soon be able to treat this condition in humans with degenerative diseases like multiple sclerosis and muscular dystrophy. Scientists injected a gene into the monkeys’ thighs that causes cells to produce human follistatin, which interferes with another compound called myostatin. Myostatin breaks down muscle, so in theory adding follistatin should encourage muscles to grow [Reuters].

Frankly medicine marches onward, not slowed by much even ethical concerns.  As medicine becomes 'corporate' one wonders if the 'customers' who demand doping protocols, and who can afford the costs won't be rewarded in the future with out-sized sports achievements.  Kinda like buying the World Series...or buying a gold medal.

Reds Bronson Arroyo unapologetically takes banned supplements: Wastes money

Cincy Reds pitcher Bronson Arroyo says he takes MLB banned supplements, and brazenly awaits the consequences.  (USA Today)

Unless Arroyo is taking nasty stuff with honest to goodness 'roids, he is simply wasting his money.  Caffeine may benefit his performance some, but really taking unproven, untested supplements that promise everything is simply foolish.

Cincinnati Reds pitcher Bronson Arroyo reaches into his locker, pulls down a clear cellophane bag and slowly opens it.

He shakes out the contents like a kid on Halloween night. There are different-colored pills, powders, liquids, proteins, caffeine concentrates and ginseng, products such as creatine, Triflex and xelR8 found at local vitamin stores. Most of the products have not been approved by Major League Baseball for use by players, Arroyo says. Some of the items have the potential to trigger a positive test under baseball's performance-enhancing drug policy. Arroyo takes them anyway.

"I have a lot of guys in (the locker room) who think I'm out of (my) mind because I'm taking a lot of things not on the (MLB-approved) list," Arroyo says. "I take 10 to 12 different things a day, and on the days I pitch, there's four more things. There's a caffeine drink I take from a company that (former teammate) Curt Schilling introduced me to in '05. I take some Korean ginseng and a few other proteins out there that are not certified. But I haven't failed any tests, so I figured I'm good."

News for Arroyo: You may not be crazy for all those supplements, but you are foolish.  Most are not worth a damn thing.  Sorry to bring science into superstition.

Tour de France 2009 now detects Synacthene (ACTH) in dope testing

One of the stealth drugs to enhance cycling performance over the years , Synacthene (or Synacthen) will be detectable in the 2009 Tour de France.  Synacthene is ACTH or Adreno-cortical stimulating hormone.  The drug would stimulate the adrenal grand to pour out cortisol, a natural steroidal hormonal with multiple physiological effects.

Anecdotal evidence from cyclists using the drug say if used correctly the substance decreased last race inflammation, and improves performance; however street talk alos says that if used inappropriately the drug can decrease cycling efficiency.  Who knows..there ar no scientific studies of the agent.  To SBS:

Anti-doping authorities have perfected a new test capable of detecting the drug Synacthene and it is currently being used by doping controllers at the Tour de France, sources have told AFP.

The substance, a synthetic hormone also known as ACTH, has up to now proved virtually impossible to detect and evidence has been limited to allegations made by ex-users.

The new test has been perfected by specialists at the Anti-Doping Laboratory in Cologne and was tried out experimentally at German cycling events last year before being approved by the International Cycling Union (UCI) as part of its new battery of anti-doping measures.

"It is based on urine samples but can also be applied to blood samples," said Professor Mario Thevis, who developed the system.

"We prefer, however, urine because there are larger volumes and more samples available."

"Of course, Synacthene was considered relevant and important, but blood testing was not as frequent at that time and the first method was based on blood specimens," Prof Thevis said.

"Moreover, the collection and storage conditions were critical: nowadays everything is harmonised."

Experts say Synacthene has typically been used in association with anabolic steroids and testosterone, the cocktail of drugs being injected directly into a racer's body to boost resistance to pain and to enhance performance.

According to anti-doping expert Dr Jean-Pierre de Modenard, there is evidence of the drug having being used for many years - not just in cycling, but also in football.

Dr. de Modenard hopes the discovery will help fill one of the remaining gaps in knowledge relating to illegal susbtances.

"To state that only one percent of controls turn up positive is hypocritical, and this has been the perfect example of what happens when there is a lack of data," he said.

Steroids ruin Earth Day

Steroids didn't really ruin Earth Day, celebrated by President Obama who flew into Newton Iowa, about an hour from.  However, studies show a significant amount of the drugs in ground water.

It’s been 39 years since the first official Earth Day in 1970. Wisconsin senator Gaylord Nelson founded Earth Day as a protest "to shake up the political establishment and force this issue onto the national agenda.” And, according the Earthday.net, the world of unaddressed pollution being accepted as the “smell of prosperity” would no longer be the norm.

Unfortunately, it seems that the original message has been subtly redefined. Yes, we have made major strides at reducing visible pollution, but our poisoning of our planet continues unabated. We decided that carbon dioxide made our air look bad and worked to curtail its emissions. At the same time, a much more insidious toxin called carbon monoxide became predominant in carbon emissions.

Plants, those green things we count on to provide us with oxygen, take carbon dioxide and turn it into breathable oxygen for the planet and turn the carbon into their own growth. On the other hand, carbon monoxide is highly toxic, although useful in a myriad of chemical application.

We don’t see nearly as much garbage in our rivers and streams as we did 40 years ago, but groundwater contamination from invisible, man made, pollutants is a huge problem. We genetically modify and chemically alter our foods now. We modify animal feed to fatten them up quicker for market purposes. Steroids and antibiotics are also used to fatten up the animals we eat. And we spray our foods with pesticides to improve our crop yields. Is this good for us?

Don't blame us.  We ate some delicious antibiotic free chicken at Panera the other day.  No mention of steroids or not...

German scientists claim lab test detects gene doping

The next big trend in doping will be gene doping...the implantation of genes to develop strength, endurance, coordination, or stamina.  If this process isn't already on the steroid black market, it appears to be a major future challenge, as the technique is undetectable.  Or thought to be undetectable; a German lab says it developed a process to detect gene doping.  From Deutche World:

German researchers say they have successfully developed a test to detect instances of gene doping. As doping in the sports world becomes more sophisticated, genetic engineering is seen as the next major threat.

The test traces a special substance, known as GW1516, which artificially increases the volume of so-called endurance muscles and enzymes that gain energy from fat. 

"For the first time, a substance for gene doping has been traced through mass spectrometry," the German Sports University Cologne (DSHS) said of the procedure, which was announced this week.

Mario Thevis, a researcher who helped develop the test, said it was ready for use.

Lance Armstrong backs out of Don Catlin anti-doping protocol

Lance Armstrong announced he will be butting out of UCLA doping guru Don Catlin's custom made anti-doping program.  Armstrong announced -- amid huge fanfare at a Bill Clinton conference last fall -- that he would undergo Catlin's state of the art anti-doping program to prove he was ahead of the curve in dope testing, and to prove he was clean.  Does this mean he is neither?  What spin will be weaved on this announcement.  To the Sydney Morning News:

LANCE ARMSTRONG may have scrapped plans to put himself through an independent anti-doping program run by world-renown expert Don Catlin but he will undertake the control system in place for his Astana team.

Armstrong's management was quick to clarify the status of his testing protocols after news reports said Catlin and Armstrong's management had been unable to put their proposed testing regime in place.

Armstong's agent and lawyer, Bill Stapleton, said: "After a thorough review of the efficiency of a separate testing program, the decision has been made to transfer the comprehensive program we had planned to do with Don Catlin to Rasmus Damsgaard, a renowned anti-doping expert who runs the Astana team's internal testing program."

Armstrong will go with Astana's anti-doping program...Astana which withdrew from the Tour de France in 2007 when Vino Alexandre Vinokourov tested positive for blood doping.

More on Armstrong and Catlin after the jump...

Concussion shows severe damage in NFL player's brain(s)

Everyone knows a football isn't a contact sport; football is a collision sport.  As the players become bigger strong and faster, the collisions become larger, louder, and more frightening.  And who doesn't like it when a player gets lit up on the field?  The player's brain doesn't appreciate too much.  CNN carries the story.

Concussed players describe depression, cognitive troubles, and mood lability.  Add these problems to the mood lability induced by steroids (or brain changes) and you have serious troubles.  About the concussions:

For years after his NFL career ended, Ted Johnson could barely muster the energy to leave his house.

"I'd [leave to] go see my kids for maybe 15 minutes," said Johnson. "Then I would go back home and close the curtains, turn the lights off and I'd stay in bed. That was my routine for two years.

"Those were bad days."

These days, the former linebacker is less likely to recount the hundreds of tackles, scores of quarterback sacks or the three Super Bowl rings he earned as a linebacker for the New England Patriots. He is more likely to talk about suffering more than 100 concussions.

"I can definitely point to 2002 when I got back-to-back concussions. That's where the problems started," said Johnson, who retired after those two concussions. "The depression, the sleep disorders and the mental fatigue."

Until recently, the best medical definition for concussion was a jarring blow to the head that temporarily stunned the senses, occasionally leading to unconsciousness. It has been considered an invisible injury, impossible to test -- no MRI, no CT scan can detect it.

But today, using tissue from retired NFL athletes culled posthumously, the Center for the Study of Traumatic Encephalopathy (CSTE), at the Boston University School of Medicine, is shedding light on what concussions look like in the brain. The findings are stunning. Far from innocuous, invisible injuries, concussions confer tremendous brain damage. That damage has a name: chronic traumatic encephalopathy (CTE).

We have referenced the synergistic effect of concussion with steroids, opiates, and other drugs (like alcohol) in producing bad outcomes...as with Chris Benoit.  The CNN article looks at a wrestler:

In one moment, his dreams of a long career wrestling were dashed by a kick to his chin. That kick, which caused Nowinski to black out and effectively ended his career, capped a career riddled with concussions.

"My world changed," said Nowinski. "I had depression. I had memory problems. My head hurt for five years..." (CTE)

The Steelers appear plagued with concussion problems:

So far, the evidence of CTE is compelling.

The Center for the Study of Traumatic Encephalopathy, along with other research institutions, has now identified traumatic encephalopathy in the brains of late NFL football players John Grimsley, Mike Webster, Andre Waters, Justin Strzelczyk and Terry Long, in addition to McHale.

Grimsley died of an accidental gunshot wound to the chest. Webster, Long and Strzelczyk all died after long bouts of depression, while Waters committed suicide in 2006 at age 44. McHale was found dead last year of an apparent drug overdose.

"Guys were dying," said Nowinski. "The fact of the matter was guys were dying because they played sports 10 or 20 years before."

So far, around 100 athletes have consented to have their brains studied after they die.

Ted Johnson was one of the first to sign up. He said he believes that concussions he suffered while playing football explain the anger, depression and throbbing headaches that occasionally still plague him.

Johnson said he played through concussions because he, like many other NFL athletes, did not understand the consequences. He has publicly criticized the NFL for not protecting players like him.

The NFL's response:

In a statement, the NFL indicated that their staffs take a cautious, conservative approach to managing concussions.

While they support research into the impact of concussions, they maintain that, "Hundreds of thousands of people have played football and other sports without experiencing any problem of this type and there continues to be considerable debate within the medical community on the precise long-term effects of concussions and how they relate to other risk factors."

The NFL is planning its own independent medical study of retired NFL players on the long-term effects of concussion.

"Really my main reason even for talking about this is to help the guys who are already retired," said Johnson. "[They] are getting divorced, going bankrupt, can't work, are depressed, and don't know what's wrong with them. [It is] to give them a name for it so they can go get help."

Studies need to be completed on the effects of concussions, and on the synergistic effects of steroids, PEDs and concussions on the player's functioning.  The players appear to be jacked-up into oblivion as they are knocked silly.

Pro cyclists may be caught doping with blood values, and genetic tests

Our colleague Robin Parisotto, who sits on the UCI (Cycling Union) board of doping reveals that doping charges may be levied by radical changes in pro cyclists's blood indices.  Story at The Australian.

THE first case of a cyclist being charged with doping on the evidence of his blood profile is expected to be prosecuted in the coming months, according to Australian anti-doping expert Robin Parisotto.

The International Cycling Union (UCI) has been building up blood profiles of its professional cyclists by taking thousands of blood samples over the past year.

Canberra scientist Parisotto, who sits on the UCI panel overseeing the anti-doping program, said yesterday more than 30 suspicious samples had been analysed and there was enough evidence to pursue a handful of riders for doping violations.

"We are only collating the results now but I expect in the next few months the UCI will be taking action against some cyclists," Parisotto said.

Sounds like the decisions about whom to prosecute are looming.

The blood profiling is designed to identify any cyclists using banned drugs or methods which manipulate the blood to improve endurance. He said suspicious samples usually contained high haemoglobin levels, or unusually low levels (which would indicate a cyclist was extracting blood to be re-injected during competition).

"There are discussions now about which are the strongest cases to go after," Parisotto said. 

"There's only a handful they can confidently follow up. But I believe in some cases the results are fairly strong and the athlete will have a hard time explaining them."

The first cycling case will be a test for this new method of identifying drug cheats.

Parisotto said there was a smaller number of suspicious samples than he would have expected if the program had been in operation three or four years earlier.

"Now there is more of an effort being made to weed out the cheats and I think some of them are getting scared," he said.

"The risk of getting caught is becoming much greater now that they have to worry about what's in their blood."

Indices to monitor include red blood cell parameters (hemoglobin, and hematocrit), EPO, and other physiological measures, that should be very stable in an individual athlete over time.  Also, Parisotto speaks of monitoring the response of particular genes to doping drugs, a very interesting development.

Parisotto, who developed one of the first tests for the blood booster EPO in the lead-up to the Sydney Olympics, is also working on the next weapon in the anti-doping war, genetic profiling.

"The technology is there now to do gene profiling on blood tests," Parisotto said.

He said any use of blood doping would show up in changes to an individual's gene activity.

The laboratories will just have to chart the abnormal changes that the drugs make to the blood and genes of the athlete.

No more track and field world records without steroids or doping?

As noted by the Irish Times, there were 11 track and field world records broken in 2008, which the author considered remarkable (nothing like the deluge of swimming records).  There was also this statement:

...the only way a world record is likely to be broken is if the athlete is on industrial amounts of steroids or a product of genetic doping, or indeed both.

Lets go to the set up for this conclusion.

Although 13 world records were set during 2008, one French study suggests the days of this happening are now numbered...

Seven of the world records were in men's events: the 100 metres (twice, by Usain Bolt); the 200 metres (Bolt, again); the marathon (Haile Gebrselassie); the 110 metre hurdles (Dayron Robles); the 4 x 100 metre relay (Bolt, again, with some Jamaican company); and the 50 km walk (Denis Nizhegorodov).

The women didn't do badly either, with six world records: the 5,000 metres (Tirunesh Dibaba); the 3,000 metres steeplechase (Gulnara Galkina); the javelin (Barbora Spotakova); and the pole vault (thrice, by who else but Elena Isinbaeva).

Given it was an Olympic year there was always going to be some exceptional performances, and yet the flurry of records during the summer still caught a lot of people off guard. Actually, at the start of the year, a study carried out by the French Institute of Sport (Irmes) concluded that the days of world records in athletics were numbered, and would run out in 2060 - after which date no more world records would be set.

Why would there be a limit to human performance?

Irmes analysed all 3,260 world records set since the first modern Olympics in 1896, and, in the end, reckoned athletes are coming very close to reaching their physiological limits. They noticed a common pattern for all events, and based on their mathematical model, estimated that athletes were operating at 75 per cent of their potential in 1896, while in 2008, they would be operating at 99 per cent.

By 2027 the athletes in about half of the events will have reached 100 per cent, and by 2060 they all will. After that the only way a world record is likely to be broken is if the athlete is on industrial amounts of steroids or a product of genetic doping, or indeed both.

That's a study for another day, and in the meantime it's up to athletic freaks such as Usain Bolt.

Exactly.  What about the influence of drugs, and of technological advances in the sport?  We have argued that doping pulls along the non-doped competitors, although we have no data to support that conclusion.

But what the Irmes study didn't predict was where exactly the records will finish at. Some may well be finished already. The 10.49 that Florence Griffith-Joyner ran for the 100 metres back in 1988 hasn't been touched in the years since, nor does it look likely to be. Without going into the gruesome details of the rise of Flo-Jo, as she was affectionately known, (widespread rumours of steroid abuse, dead at 38) only one other women has run under 10.7 seconds for the 100 metres, and that was Marion Jones.

In other words Flo-Jo's record is unlikely to be broken before 2060.

There are several other dodgy records in the books and they are unlikely to be broken before 2060 either. Unless of course the IAAF finally gets some sense and remove all world records from the drug-infested 1980s.

As the author  points out, other studies suggest that the limits of human performance have not been reached:

In another study just published by the Journal of Experimental Biology, Mark Denny of Stanford University looked at the limits to running in humans, compared to dogs and horses, and came to some conclusions of his own.

Denny reckoned that the 9.69 seconds that Bolt ran for the 100 metres in the Beijing Olympics can definitely be improved, and put the absolute human limit at 9.48.

Likewise, he believes Flo-Jo's record will go and that a woman can someday run the 100 metres in 10.39.

Dogs and horses, he says, already reached peak speeds in the 1970s, while humans are still getting faster. And Bolt is ample proof of that.

A more basic study was carried out on Bolt shortly after Beijing, when Norwegian physicist Hans Eriksen analysed TV footage of the Olympic final and estimated that Bolt would have run 9.55 seconds had he not slowed down to punch his chest and acknowledge his own extraordinary performance.

Even the long distances have some room for improvement. When Gebrselassie ran his 2:03.59 for the marathon last September it seemed the magical two-hour barrier was edging ever closer, yet Denny puts the human limit for running 26.2 miles at 2:00.47.

The women are already closer to their limit, as he reckons Paula Radcliffe's world record of 2:15.25 can only be trimmed to 2:14.97.

(more after the jump, if you can break the record)

Gene doping is OK? Conference attendees (Dope Now) say yes

Always someone pushing the envelope, or the needle as it were.  The WaPo publishers a piece on the gene doping conference held in Washington.

Gather a roomful of anti-doping experts, administrators, academics and athletes alike _ something a conservative think tank did Thursday _ and there is no consensus as to whether gene doping, thought by some to be the next frontier in Olympic cheating, is at hand.

Indeed, there isn't even consensus on whether it would be a bad thing.

Turns out there is a school of thought _ "pro-doping," it's called _ that suggests anything athletes do to improve performance is OK, even, for example, manipulating DNA or surgically enlarging the webbing between fingers and toes in order to swim faster.

So says Andy Miah, who teaches at the University of the West of Scotland and was among about 10 panelists who participated in Thursday's conference on "The Coming Age of the Uber-Athlete: What's So Bad about Gene Enhancement and Doping?" at the American Enterprise Institute.

According to Miah, academics are taking CERA EPO to be able to rush faster into the Dope Now camp.

Gene doping, which is banned by the World Anti-Doping Agency, is a spin-off of gene therapy, which typically alters a person's DNA to fight diseases.

Miah advocates "celebrating the value of performance enhancement," he said.

"I don't think a public health crisis would arise from enhancement technologies," he added.

Miah said there is a growing group of professors around the world _ "Four years ago, there were half as many people as now," he noted _ who back his "World Pro-Doping Agency" thought experiment. One of his premises is that sports wrongly are thought of as a separate entity, different from other pursuits or professions _ music, art, medicine _ where no one objects to, essentially, doing whatever one can to be the best one can be.

"We are more willing to embrace these enhancements, with the caveat that we need them to be safe enough," he said. "We don't all want to kill ourselves by using these things, but we are interested in exploring the realm of human embodiment that is beyond our current capabilities _ and that might be cognitive, it might be physical. And I think that's where sport isn't quite at yet."

Is Miah qualified to discuss health complications?  No, of course not.  And the rush for the Dope Now organization...probably doubled form 2 to 4.

Ignore the rules.  Ignore sportsmanship.  Ignore the very real threat to morbidity and mortality.  Ignore the science.  Ignore the fact that gene doping has never been researched in an appropriate test group...or any group.  Ignore the costs.  Let's just be cool and hip.  To Edwin Moses:

Other speakers Thursday included Olympic champion hurdler Edwin Moses and U.S. Anti-Doping Agency CEO Travis Tygart, who believe gene doping should be banned, worry what it could do to athletes _ and agree someone is likely to try eventually.

"How do you feel if it's your son or your daughter who wants to be an Olympian? Would you let your kid or your grandchild take what they have to take? Or do what they have to do?" Moses asked.

On the other hand, he acknowledged there are those who will.

"If you have experts saying it's realistic to turn on pieces of your metabolism and it becomes feasible for the athletes to do something without killing themselves and it's not tremendously expensive, someone is going to try it," said Moses, who won gold medals in 1976 and 1984 in the 400-meter hurdles. "There will be someone who can convince an athlete they can get away with it."

An American swimming coach lays it all out:

John Leonard, executive director of the American Swimming Coaches Association, told of conversations he has had with coaches and scientists in China.

"We are really naive if we are to believe that the Chinese at this point are clean or that they are the only country in the world that is experimenting with genetic enhancement as we speak," said Leonard, who was not a panelist but attended the conference and spoke during question-and-answer periods.

"There are lots of countries in the world who couldn't care less about doing it safely, and there are lots of athletes who will take the chance that they will die in order to win medals. ... Will the United States have the same viewpoint when we start losing gold medals?"

Of course athletes will cheat to win.  How about those side-effects?  Enter Theodore Friedman, an actual scientist:

Theodore Friedmann, a professor at the University of California, San Diego, researches human gene therapy and spoke about the risks.

"People are injured. People die," he said. "It should be reserved for treatment of people with serious diseases."

He said he doesn't know whether there are athletes attempting gene doping.

"Nobody knows," he said, before adding: "It wouldn't surprise me."

About one thing Friedmann left no doubt, however: Unlike Miah, he thinks the practice has no place in sports.

"The anti-doping world accepts the notion that rules matter and, in fact, it reflects the wish of most athletes," Friedmann said. "The world of pro-doping is the contrary of all that."

George Mason University professors develop urine HGH test

Remember George Mason's deep run into the 2006 NCAA basketball tournament?  That's not the point here.  The point is Mason professors moved doping tests forward with the development of an HGH urine test.  USA Today says so:

Just as George Mason University's athletics program was overshadowed in the Washington, D.C., region — never mind the nation — until its men's basketball team made a surprising run to the NCAA Final Four two years ago, the school's medical research program had worked in relative obscurity until a major breakthrough this summer.

Two GMU professors whose primary interest had been cancer research developed the first urine test for human growth hormone. Working outside the Olympic movement, outside the traditional research environment of a university-backed teaching hospital, and 20 miles outside the university's main campus in Fairfax, Va., Emanuel "Chip" Petricoin and Lance Liotta moved directly to the forefront of international sports' anti-doping efforts. They also furthered — at least for now — their university's high-risk, high-reward pursuit of national renown and future income.

The Mason technology utilizes nanotraps to grab minute amounts of HGH in the test tube.  Although not specified, the isolated HGH molecules then must be identified as exogenous to the athlete.

It wasn't until earlier this year that they began to alter a test — which they hope one day will be able to detect cancer at its earliest stages — to find HGH in urine. There has been a blood test for HGH for a few years, but it's extremely expensive and its reliability has been questioned within the anti-doping community. The test has been used at the last three Olympics but has failed to identify an athlete using HGH. There is no indication major sports leagues or their players' unions are eager to implement it.

Mixing chemicals that cost less than $100, Petricoin and Liotta created a reaction in the lab that creates millions of nanoparticles tailored to find HGH — and, one day, possibly cancer. The particles, which would be placed in a specimen container before collection, find, trap and preserve the compound so standard testing equipment can detect HGH.

The next step is having their research accepted by the scientific, athletic and legal communities. That process took a step forward last week when their research into the HGH test was published in Nano Research, a peer-reviewed journal specializing in the science of engineering on an atomic and molecular scale.

Ceres, the biotech company, is cooperating with the U.S. Anti-Doping Agency for the next phase: identifying a normal range of HGH in the body. The study will take urine from dozens of adults 18 to 45 who volunteer to give samples at an on-campus athletics facility.

The professors are still early in the approval process, which could take years, according to Frederic Donze, a spokesman for the World Anti-Doping Agency, which approves testing procedures used in Olympic sports.

"There is usually a long way between research and implementation of a methodology for anti-doping purpose," Donze says via e-mail. "A significant element of this process is that the anti-doping community needs to make sure that any detection method can withstand any … scientific and legal challenge."

The most recent incarnation of the test for endurance-boosting EPO — a test that has flagged several cyclists at the Tour de France and a handful of athletes at the Beijing Olympic this summer — took four years, Donze says.

Don Catlin, who founded the UCLA Olympic Analytical Laboratory and is widely viewed as the dean of anti-doping research, spent years seeking this HGH test and has been in constant contact with the professors in hope of getting their test accepted.

"We have made substantial progress," says Catlin, who sat alongside Liotta during a panel discussion at a summit about HGH that Major League Baseball sponsored last month. "I'm excited about it. We have Dr. Liotta, who walks in as a breath of fresh air with a new technology."

The USA Today piece focuses on the entrepeneurial aspect of the Mason research.  We are excited about the anti-doping potential.

Injectable Six Packs: HGH for boomers

The AP carries a story today of one of the physicians who looks like he discovered the fountain of youth: Dr. Jeffry Life, a typical Nevada Anti-aging doctor.   These dudes manipulate lax medical boards in Nevada, juice themselves up with HGH (and likely testosterone) then tout their magnificent physiques as the 'Fountain'.

The exercise and diet part of the message is good; the anti-aging hormonal treatment is hype.  That hype will cost you 3000.00, which for some baby boomers is money wasted well spent.  And Life's serial photos show that in part exercise is well worth the effort in shaping up the physique.

Life's physique is incredible, but obviously the HGH doesn't regress the effects of aging on the face (there is always plastic surgery for that absolutely fake and phony look.  Wonder if fitness buff Jack Lalane takes HGH -- photo right at 93)

It's one of those photos that make you do a double-take. Dr. Jeffry Life stands in jeans, his shirt off. His face is that of a distinguished-looking grandpa; his head is balding, and what hair there is is white. But his 69-year-old body looks like it belongs to a muscle-bound 30-year-old.

The photo regularly runs in ads for the Cenegenics Medical Institute, a Las Vegas-based clinic that specializes in "age management," a growing field in a society obsessed with staying young. Life, who swears that's his real last name, also keeps a framed copy of the photo on his office wall at Cenegenics.

"He's the man!" patient Ed Detwiler says teasingly, pointing to the photo of the doctor who, in many ways, has become his role model.

Detwiler, 47, has been Life's patient for more than three years. In that time, he has adopted the regimen that his doctor also follows — drastically changing his exercise and eating habits and injecting himself each day with human growth hormone. He also receives weekly testosterone injections.

He does it because it makes him feel better, more energetic, clear-minded.

He does it because he wants to live a long, healthy life.

Except for one of the founders of the hype, Dr. Alan Mintz (really you could not make up these names), who died at age 69 (and not saying that's chopped liver to live to be 69) of a brain hemorrhage during a biopsy.

Dr. Alan Paul Mintz, whose controversial efforts to prolong and improve peoples' lives drew national attention, died Sunday at the age of 69.

"He was a visionary, dedicated to helping people live the most vital lives they could," said his wife of 47 years, Rabbi Yocheved. "He was the most loving husband, father, and grandfather."

Mintz was famous largely because his Cenegenics Medical Institute based in Summerlin promoted the use of steroids and human growth hormone as an anti-aging therapy for some patients, and he showcased his own bodybuilder physique as evidence of the benefits of the regimens he espoused.

Mintz died Sunday from bleeding during a biopsy, Yocheved said. Mintz had been suffering from problems with his brain, possibly because of a stroke, she said.

She said many of his patients were flying in from all over the world for his service today at 10 a.m. at King David Memorial Chapel, 2697 Eldorado Lane, near Eastern Avenue.

So many people are better because for having known him," she said.

Mintz's company, founded in 1998, grew to include offices in Charleston, S.C.; Boca Raton, Fla.; Tokyo; Hong Kong and Seoul, South Korea, and claimed to have more than 12,000 patients.

The anti-aging docs all seem like rich nice old dudes.  However, they certainly come up short when producing scientific evidence of the effectiveness of the HGH and other hormones for anti-aging.  Testosterone can clearly contribute to rippling muscles and less fat in older men; however it can also clearly increase risk of prostrate cancer, and likely stroke and other problems.

The weight training is good stuff.  Weightlifting can increase endogenous testosterone, strengthen bones, and reduce fat.  However, adding the hormones to get that entirely buff look is not only bogus, it could be dangerous.

Who cares when you can life fast, die young, and leave a good looking corpse at 69?

An earlier piece on Life also looked at the HGH Anti-aging medicine phenomenon.

With his six-pack stomach, bulging chest and bull-like shoulders, the muscleman in the newspaper advertisement displays the sort of rippling torso that adorns the cover of men's fitness journals.

But there is one difference. From the neck up, Dr Jeffry S Life is a balding 67-year-old physician.

His physique is the product not of a computer touch-up but a controversial American "ageing management" technique, that often includes a cocktail of human growth hormones and testosterone.

Some 13,000 clients have so far spent thousands of dollars on a technique known as Cenegenics (from the Greek for "new beginning"). As post-war baby boomers enter their 60s, it promises to boost performance from the office to the gym to the bedroom.

The initial one-day $2,995 evaluation at the Cenegenics Medical Institute (CMI) in Las Vegas, has already attracted a handful of unnamed Britons seeking the secret of Dr Life's remarkable torso...

 

After the initial evaluation, clients spend up to $13,000 on exercise and diet regimes, supplemented by vitamins and, in most cases, hormone replenishment such as testosterone.

Approximately 20 per cent are also prescribed injections of human growth hormones if they are diagnosed as demonstrating adult growth hormone deficiency (AGHD).

(The AGHD is fairly bogus, but so what?)

Critics say that it is unproven and potentially dangerous. Tom Perls, a professor of medicine at Boston University, expressed surprise at the number of Cenegenics clients diagnosed with AGHD, as he said the condition normally affects three people in 10,000.

In an interview outlining his philosophy last year, Dr Mintz listed a panoply of positives that he attributed to human growth hormone. They include a decrease in fat and skin wrinkling, an increase in muscle and improved mood.

"Next year does not have to be worse than this year," Dr Mintz said. "How about good sexual activity with your loved one once a week, twice a week, feeling good about it?"

Yeah, you would hate to feel really bad about it...and you're getting all that coin too...

 

Public health study shows increased violence among teenage steroid users

A multi-center authored data analysis of almost 700 survey in the Longitudinal Study of adolescent Health found a major association between endorsement of anabolic steroids and aggressiveness.  The abstract, and reference are given here:

We examined the effects of anabolic-androgenic steroid use on serious violent behavior. Multivariate models based on data from the National Longitudinal Study of Adolescent Health (N=6823) were used to examine the association between lifetime and past-year self-reported anabolic-androgenic steroid use and involvement in violent acts. Compared with individuals who did not use steroids,young adult males who used anabolic-androgenic steroids reported greater involvement in violent behaviors after we controlled for the effects of key demographic variables,previous violent behavior,and polydrug use. (Am J Public Health. 2008;98:2185–2187. doi:10.2105/AJPH.2008.137018)

These findings fall in line with previous research on the issue.  However, it should be noted that an association if not causal in itself.   (no one would attempt the study doing a double blind placebo controlled study of high dose anabolic steroids affect on violence..that is with street doses).

The conclusions:

Our results suggest that the use of anabolic androgenic steroids is related to heightened levels of violent behaviors. However, limitations must be considered. First, the measures of anabolic-androgenic steroid use were based on self-reports, not on direct measures as have been used by previous researchers.8 Another limitation of our study was that the measures of violent behavior were drawn from self-reports, which necessarily raises the question of whether the reports were reliable and accurate. With these limitations in mind, the current research suggests that the media attention and public concern surrounding anabolic-androgenic steroid use may be justified given its association with violence among males in the United States.

Report of steroid users and concomitant polydrug use

This report was published in (link) which looks at anecdotal evidence of steroid use in polysubstance users.  Although it is true that polysubstance users use many drugs, this isn't really a 'study'.  This is a hypothesis generating paper, and not a hypothesis testing study.

The inappropriate use of anabolic androgenic steroids (AAS) was originally a problem among athletes but AAS are now often used in nonsport situations and by patients attending regular addiction clinics. The aim of this study was to improve understanding of the development of multiple drug use in patients seeking treatment at an addiction clinic for AAS-related problems.

Methods: We interviewed six patients (four men and two women) with experience of AAS use who were attending an addiction clinic for what they believed were AAS-related problems.

The patients were interviewed in-depth about their life stories, with special emphasis on social background, substance use, the development of total drug use and subjective experienced psychological and physical side effects.

Results: There was significant variation in the development of drug use in relation to social background, onset of drug use, relationship to AAS use and experience of AAS effects.

All patients had initially experienced positive effects from AAS but, over time, the negative experiences had outweighed the positive effects. All patients were dedicated to excess training and took AAS in combination with gym training, indicating that the use of these drugs is closely related to this form of training.

Use of multiple drugs was common either in parallel with AAS use or serially.

Conclusions: The study shows the importance of understanding how AAS use can develop either with or without the concomitant use of other drugs of abuse.

The use of AAS can, however, progress to the use of other drugs. The study also indicates the importance of obtaining accurate, comprehensive information about the development of AAS use in designing treatment programmes and prevention strategies in this area.

Myostatin blocking gene therapy to be introduced for dogs; when will the first human athlete abuse it?

Prof Lee Sweeney of the University of Pennsylvania will be behind the introduction of a gene therapy approach to treat aged dogs who suffer muscular weakness.  Apparently elderly dogs who become progressively weaker (this is generally called old age) need treatments so their owners can take the canines on walks.  The therapy involves the injection of a genetically modified myostatin inhibitor that produces incredible muscular hypertrophy; the injection goes into the animal's liver.

Once this gene therapy reaches the public, h ow long will it be before an existing sports record becomes totally obliterated by newly enhanced and genetically modified athletes?

This raises several issues just in the vet use of the technique:

• Isn't aging natural?  Do elderly dogs -- as lovable as they are -- really need to be revitalized so the owners can walk them?  At what cost?
• Might counseling on the normal aging in biology be more effective?  Aging is part of every organism.  Why fight the changes that are inherent in the DNA of the animal, to protect the fragile emotional status of the owner?

To the Telegraph:

An American professor is preparing to market a form of canine gene therapy, which would see dogs injected with substances which switch off the genes that regulate their muscle growth.

Prof Lee Sweeney, from the University of Pennsylvania, has pioneered research into gene transfer technology, a field in which poorly functioning and abnormal genes are manipulated, switched off or replaced.

Ten years ago he created "mighty mice" in the lab with enormous muscles and strength in old age. Now he says experiments on dogs have been so successful that he is preparing to market the treatments to owners of ageing pets across the United States.

He said: "We are now in the final stages of getting all the approvals to offer this through the veterinary hospital as a treatment to try to improve strength in pet dogs.

"As the dogs get weak their owners get upset that they can't walk around any more. So we're hoping that within the next year we will begin the era of genetic enhancement in dogs."

Under the therapy, dogs would be given an injection into the liver of an inhibitor which switches off the gene which produces myostatin, a protein which inhibits muscle growth in animals and humans.

One would hope Sweeney has considered the implications of his genetic enhancement.  The first issue is the economic issue of enhancing an aging dog to mollify the owner.  Obviously an aging animal in the wild gets eaten, which is not a good outcome for a domestic pet.  Domestic pets decline gradually, with the resultant dysfunction experienced by all aging organisms; pet owners keep the animals comfortable until the inevitable sad day when the pet can longer function well.   But does this justify an attempt to allay the aging process in a canine?  At what price? 

Sweeney must consider that if the gene therapy is marketed to vets, that soon, genetically enhanced greyhounds will be winning the dog races.  Once the Schwarzenegger greyhounds win races, human athletes will take notice; actually they already have.  To the Telegraph again:

He (Dr. Sweeney) gets between five and 10 emails a week from athletes, some from Britain, and so many phone calls that his secretary has stopped putting them through.   And that is in a quiet week.

If he publishes an academic paper or does a media interview, a flurry of 50 or   more calls and emails usually follows, as it did 10 years ago when he first   revealed his 'mighty mice' to the world at a meeting of the American Society for Cell Biology – laboratory mice with enormous muscles that retained their   strength and regenerative ability even when the animals reached old age.

Sweeney's super-strong rodents were the product of his pioneering research   into gene transfer technology and the implications were clearly not lost on the athletes and coaches who got in touch, one of whom offered $100,000 for what the mice were getting.

Shockingly, Sweeney also received a request from a high school American football coach for his entire team to be genetically modified.

Sweeney told him what he is still telling everyone a decade later, that bulking up on gene therapy is not yet safe enough for humans and would require heavy-duty immune suppression. He always gets the same response.

"Even if I explain to them that to make it work might require all sorts of heroic measures, they basically say, 'Fine. I'll do it'. And if it's a matter of money, they'll get the money."

Sweeney has never been contacted by a name he recognises – "I don't get Barry Bonds calling me up" – and says most of the would-be guinea pigs appear to be young athletes trying to make the big time.

"Some of them are from Europe," he says. "I get quite a few   from the UK and Germany."

He says he would feel uneasy about passing on their names to the anti-doping authorities but is sufficiently concerned to have accepted a seat on the gene-doping panel of the World Anti-Doping Agency (Wada), who are funding   eight research projects on gene-doping detection in a desperate attempt to stay ahead of the cheats.

Sweeney is bracing himself for another surge of calls and emails next year when his work moves from the laboratory to the commercial world with a muscle-building gene therapy for dogs.

Even though Sweeney knows the illicit demand for the mystatin inhibitor, he will market the drug anyway...ah the power of economic windfalls can outstrip the ethical considerations of the enhancements.

We have a chapter on genetic enhanced performance (GEP) or Performance Enhancing Genetics (PEGs) that looks at the issues. Sweeney has considered the issues too as summed up by the Telegraph:

Sweeney hopes his new canine anti-aging treatment will be just the start.  Humans have the same gene that Sweeney is manipulating in dogs and the nex  step will be to treat people with serious genetic diseases such as muscular dystrophy. Ultimately, he hopes to give the elderly, like the pampered  pooches of Pennsylvania, greater muscle strength and mobility in their final   years.

But any breakthrough will inevitably be seized upon by dope cheats in the same way that clinical drugs such as steroids, human growth hormone and the red blood cell-boosting EPO soon found their way into kit bags. With the prospect of as yet undetectable, lifelong enhancement, how could any drug cheat resist?

As gene transfer technology enters the medical mainstream as a treatment for numerous diseases from blindness to cancer, scientists are agreed it is only a matter of time before it crosses over into sport.

Some predict that London 2012 could be the first genetically modified Olympic Games. Others say the Beijing Games may already have that dubious honour.

Here is a therapeutic enhancement that may render all PEDs obsolete.  The results are shockingly dramatically impressive; the technology undetectable at present; and the technique will soon be available.

Performance Enhancing Drugs are simply amateurs when compared to the potential power of Performance Enhancing Genetics.  Looks like that brave new world of astonishing sports feats will be ushered in very very soon.

Steroid use in Iowa youth

We presented a scientific 'paper' (poster exactly) today in "Steroid Use in Iowa Youth" here in Chicago at the American Academy of Child and Adolescent Psychiatry.  In 85,000 survey questionnaires filled out by 6th, 8th, and 11th graders, 2.5% of males, and 1.2% of females endorsed anabolic steroid use at some time in life.

The use of steroids increased with increasing grades and age.

Of course a survey is not foolproof...students can exaggerate, or may misread the question.

These data are not earthshaking, however this the largest cohort ever surveyed...and those numbers are significant in a rural state.

Steroid use in youth is not without side effects.  Consider Taylor Hooton, who father Don will join us in Chicago a presentation on Saturday.

Are doctors using performance enhancing drugs?

An article from the the Sacramental Bee, by Dr. Michael Wilkes, looks at the use of 'stimulants' and PEDs for physicians.

Doctors have long prescribed pills to help people concentrate, stay awake, go to sleep, remember facts, control their moods and enhance endurance in such tasks as flying and studying.

Now, doctors are also using these drugs – not to correct abnormalities but to enhance their abilities.

Advertisements for Provigil and other drugs promise that they will help doctors stay awake.   

The practice of medicine requires long hours, constant learning and a high level of dedication. Physicians work at all hours of the day and night, making life-and-death decisions.

Don't patients benefit if doctors take pills that will help them stay awake during a long overnight shift in the emergency room or provide better concentration to a surgeon doing a 10-hour operation?

Dr. William Cheshire, writing in the journal Virtual Mentor, asserts that the field of medicine has traditionally drawn a line between treatment (to restore or preserve vital functions) and enhancement (to provide abilities that go beyond normal function).

If the practice of medicine has been devoted to treatment, does that preclude doctors from dealing with enhancement? Certainly in some areas, such as plastic surgery, enhancement – not treatment – is the rule.

In some nonmedical fields, enhancement might provide a competitive and selfish advantage – e.g., working longer hours to impress the boss or taking steroids to beat other athletes.

I have spoken with doctors who feel that enhancing pills help protect their patients and society. For example, they ask, what if two patients urgently need surgery? Without a drug to stay awake, the surgeon could perform just one surgery. With medication, he could operate on one patient and then the other.

Wait a minute, though. Do we want doctors operating after they have taken these pills?

I have colleagues who say these pills are no different than a couple of cups of coffee – just a bit stronger. Is that true? What happens when the pills wear off, and what about the side effects?

There is little or no data on how these drugs affect a doctor's performance.

Until we have more data, doctors should not be allowed to take these medicines when on duty.

If doctors are tired, they should sleep. If they can't concentrate, they should explore why. Medicating our physician to work longer, harder and with superhuman concentration is just not in society's interest – at least not without substantial research.

   

As we say, one of the largest challenges in the new science age of the 21st century comes in determining the ethics behind performance enhancement: how far, how much, how moral.  This central question cuts across all ages, professions, and economic groups.

Is the 2008 Tour de France done? Indications no more CERA EPO positives

The 2008 Tour de France may be done finding drug-cheats. At least AFP thinks so:

Austria's Bernhard Kohl will be the "seventh and last" positive doping case from this year's Tour de France, according to sports daily L'Equipe on Tuesday.

Kohl, the best climber at this year's race where he finished third overall, has become the fourth rider to test positive for CERA, a new generation of the banned blood booster EPO (erythropoietin).

Here is the tally for doping in 2008 Tour de France, of which 4 were CERA EPO:

In all seven riders tested positive at this year's race, which was won by Spaniard Carlos Sastre of the CSC team.

Italians Riccardo Ricco and Leonardo Piepoli and Germany's Stefan Schumacher all tested postive for CERA, which until recently was thought to be undetectable.

During the race Ricco, the winner of two climbing stages, was ejected along with his Saunier Duval team after urine samples belonging to the Italian revealed traces of CERA.

Ricco followed Spanish duo Manuel Beltran, of Liquigas, and Barloworld rider Moises Duenas in leaving the race, both of whom tested positive for EPO.

On the race's final day it was revealed that Dmitri Fofonov, a Kazakh who rides for Credit Agricole, tested positive for a banned stimulant. He has since been banned for three months.

Weeks ago it was confirmed that Ricco's teammate Piepoli, a climber who won the 10th stage to Hautacam in the Pyrenees, also tested positive for CERA.

Then last week Schumacher - Kohl's team and room-mate at Gerolsteiner - was also confirmed as having tested positive for CERA. The German won both time trials on the race.

On Monday Kohl was the latest rider to be snared for using EPO to oxygenate his blood cells, thus boosting his abilities to perform on the world's toughest bike race.

And this is it for CERA positives:

Although it had been reported recently that France's national anti-doping agency was set to reveal a deluge of positive tests, L'Equipe said Tuesday the Kohl positive case "is the seventh and last positive, according to our information".

The French anti-doping agency (AFLD) was in charge of this year's controls as the Tour was being held outwith the auspices of the International Cycling Union (UCI) because of a dispute, which has now been resolved.

The AFLD recently pioneered a new blood test for CERA, the latest generation of a drug which has been in use in endurance sports since the early 1990s.

Wednesday Steroid Injections

1.  Penn State professor publishes study looking at popular media impressions of accused MLB drug cheats.  (The Daily Collegian online)

2.  Steroids can produce testicular dysfunction (Uro today)

3.  Is GW1516 -- affects PPAR-delta -- already doping up athletes?  (Destination Sante)

Greg LeMond interrupts the 'Feel Good' LA tour; peppers the Armstrong team with doping questions

Cojones.  That is what Greg LeMond displays in spades.  LeMond attended yesterdays press conference in Las Vegas, at the Interbike trade show.  If Armstrong wants publicity, then he should deal with the tough issues too.  To Bike Radar:

A day after officially announcing his comeback to professional cycling, Lance Armstrong made an appearance at the Interbike trade show to give the cycling media and industry an opportunity to hear more details of his plans, including the special testing by Don Catlin of the UCLA anti-doping lab. Catlin joined him on stage along with American Taylor Phinney, who will lead Armstrong's new U23 developmental team.

Sitting in the front row, asking the first question was another Tour de France champion and outspoken critic of Armstrong, Greg LeMond. Cyclingnews was on hand to hear the plans and questioning from the industry, including LeMond.

LeMond, seated in the front row, led off the questioning with some pointed ones, all surrounding the theme of questioning the reasonability of the planned special testing of Armstrong by Don Catlin of the UCLA lab.

Very topical questions for Team Armstrong.  Or should we say Corporate Armstrong.  If an athlete is going to trumpet state of the art doping testing, then make it state of the art.  Look at more than the 'forensic' lab tests (drug level, or T/E ratios).   Look at physiologic functions and blood parameters for irregularities.

"I see Mr. Greg LeMond is here," Armstrong said somewhat wryly, but allowed him to have the first question.

LeMond pressed Armstrong and Catlin about the type of testing they had planned. He levied some reasonable critiques, essentially calling into question the proposed testing, arguing that it is not comprehensive enough, such as using T/E ratios and tests for specific EPO drugs as opposed to measuring physiological variables such as power output changes over time. LeMond inferred that a spike in power output would better indicate the use of something compared to trying to test for particular substances.

"That is not my area," responded Catlin. "He will be subject to testing by everyone under the sun. I think that will be all sorted out."

Catlin is a good guy; we hope he is not seduced by the Armstrong mystique and the Armstrong financial power.  For too long stars tend to intimidate people; even in Congress, members were asking Roger Clemens for autographs rather than grilling him about his doping agenda.  LeMond is not easily intimidated as we can see below. This exchange proved pretty testy:

Catlin said that the actual program is still taking shape. "[Lance] has agreed to a couple of a few very fundamental points. One is his data, like T/E ratio and all that kind of stuff that a doping control is allowed to do will be on the web, so you can see it. 'Ah, your T/E ratio changed today, what happened?' Like to see if he is taking EPO – all the actors to make it a very public campaign.

"The other thing is samples will be kept frozen for a good long time so that if next year, five years a new test comes out and someone says Lance was doing something five years ago, we can pull out the samples and test them. This is longitudinal testing whereas the usual type of testing is taking a stop in time. This is where you connect the dots and is much more powerful kind of program to understand the physiology."

"That is all irrelevant," LeMond responded. "It doesn't matter about T/E ratio but watts and power output..."

"I don't think it is irrelevant," said Catlin. "I dare say you know this business pretty well! Come with your ideas of what we should do!"

At that point Armstrong stepped in tried to move things along. "You've done your job," Armstrong said to LeMond. "We are here to talk about a couple of things, like the Global Clinton campaign and my comeback to cycling. It's time for us, everybody in this room, to move on. We are not going to go there, I appreciate you being here – next question."

Come on folks.  If an athlete holds a press conference to trumpet his complete transparency to anti-doping agenda, and if the athlete expects to be state-of-the-art, then the athlete needs to answer all questions completely without cutting off the questioner because the issues are too tough, or he doesn't like the path the questions are going.

This is not scientific agenda here, it is public relations.  and perhaps to sell some SRAM bicycle components.

Anabolic steroid use enhances powerlift athletes for years

In a new study discussed at the American Physiological Society, a Swedish group found that the use of anabolic steroids produced long lasting enhancement of the muscle cells.  (The Science Blog; Scientific American)

A team of researchers has examined the impact of anabolic steroid use on power lifters years after the athletes had ceased to take the drugs. The researchers found that while physical traces of the drug no longer remained, changes in the shoulder and quadriceps still gave lifters an advantage years later.

The research was conducted by Anders Eriksson and Lars-Eric Thornell, Department of Integrative Medical Biology, Section conducted the study for Anatomy, Umea University, Umea, Sweden; Christer Malm, Umeå University and Winternet and Patrik Bonnerud, Department of Health Science, Section for Medical Science, Lulea University of Technology, Lulea, Sweden; and Fawzi Kadi, Department of Physical Education and Health, Orebro University, Orebro, Sweden.

The researchers ascertained 3 subject groups: power lifters, power lifters currently using the juice, and power lifters who used steroids in the past but abstained now.  The muscle fiber and muscle groups examined:

For power lifters, type IIB fiber, the most powerful, is most frequently used. The use of anabolic steroids can add more nuclei to the muscle, and enhance muscle fiber size.

The researchers examined data in two muscles: the vastus lateralis, found in the quadriceps, and the trapezius, a part of the shoulder-neck muscle. Each muscle is key to power lifting.

The results were startling:

The researchers found that several years after anabolic steroid withdrawal, and with no or low current strength-training, the muscle fiber area intensity, the number of nuclei per fiber in the quadriceps was still comparable to that of athletes that were currently performing high intensity strength-training. They also discovered that the shoulder-neck fiber areas were comparable to high-intensity trained athletes and the number of nuclei per fiber was even higher than found in the current steroid-using group.

According to the lead researcher, Dr. Eriksson, ”It is possible that the high number of nuclei we found in the muscle might be beneficial for an athlete who continues or resumes strength training because increased myonuclei opens up the possibility of increasing protein synthesis, which can lead to muscle mass.” He added, “Based on the characteristics between doped and non-doped power lifters, we conclude that a period of anabolic steroid usage is an advantage for a power lifter in competition, even several years after they stop taking a doping drug.”

As many clean Olympic athletes argued, once a competitor used an anabolic steroid, the competitive advantage may be maintained over years.

And the NFL doles out a 4 game suspension for steroid policy violations... 

WADA chief focuses on steroid abuse at the local level

Like many before him, WADA head John Fahey recognizes that steroid and doping use by elite athletes while commanding the headlines, represents a small fraction of the illegal trafficking of the drugs.  The Age reports today that the WADA chief wants an effort on the ground to combat illicit steroid use.

WORLD Anti-Doping Authority chief John Fahey has called for sweeping research into performance-enhancing drug use in the Australian community and wants a public health campaign — similar to anti-smoking and binge-drinking efforts — to combat what he says is a growing problem.

"We have seen with things like smoking that … the more money you spend publicising the downside of smoking, the better your results are in getting people to give it up," he said.

Fahey was reacting to a spate of noted illegal imports of PEDs.

Mr Fahey's comments come as a senior customs official told The Age that the amount of performance-enhancing drugs being brought into the country had risen dramatically in the past five years and that the overwhelming majority was destined for community gyms and sporting clubs rather than elite athletes.

The WADA president has had talks with federal Sports Minister Kate Ellis to discuss an increase in government funding for research and education campigns. He has also met Professor Warwick Anderson, chief executive of the National Health and Medical Research Council, the Commonwealth body that allocates hundreds of millions of dollars each year for health-related research...

Mr Fahey said it was an important next step — a decade after the establishment of WADA — to take the fight against performance-enhancing drugs directly into the community.

"We really need to focus more generally and not just on elite (drug use)," he said. "Armed with better knowledge, we can make a better case for more attention and more funding to address the health of ordinary citizens who can suffer dreadful consequences of the problems they are creating for themselves."

Mr Fahey said governments were increasingly realising that abuse of steroids and other performance drugs was a serious public health issue and not just a problem for sports administrators

All true.  However those eleite athletes continue to serve as role models for the teeming masses of consumers...

"In most cases it is more about getting a better body or looking good for the opposite sex or the same sex," he said. "It comes down to the suburbs, the gyms and the schools. People will see a way of getting a short-term benefit in a way that in public health terms can cause extreme damage."

Recent research in South Australia indicates that body image is as important a motivator for steroid use as sporting performance and that teenage boys and gay men are big risk groups. Such substances are now referred to as performance- and image-enhancing drugs (PIEDs).

Mr Fahey said athletes had to be competing at state or national levels before they were subject to drug testing. "We do miss out on the overwhelming majority of people who are taking these things," he said.

Will they be going door to door to survey doping in Sydney?

EPO is BMOC in doping world

Erythropoietin (EPO) appears to be assuming larger and more important role in medicine, and in sports doping.  EPO, a natural hormone produced in the kidney stimulates (regulates) the production of red blood cells (RBCs).  RBC, by utilizing hemoglobin, carry oxygen loaded in the lungs to all the 'peripheral tissues' like heart, brain, muscles, gonads, etc..  Hemoglobin then captures CO2 --  a waste product from cellular metabolism -- to be carried back to the lungs where the waste C02 is exchanged for oxygen.

EPO can be abused by cyclists, and track athletes, based on the improvement of oxygen delivery to the muscles, and even the CNS.  However the use of EPO is dangerous, causing blood clots in critical vessels (like heart).

EPO became useful for the treatment of kidney failure.  Kidney failure can be caused by many diseases: hypertension, diabetes, genetic metabolic conditions etc.  Those patients suffered from anemia, treated with EPO.  From Medscape:

The use of erythropoietin (Epo) in treating anemia of chronic kidney disease (CKD) has transformed the lives of millions of individuals.^[1] In the pre-epoetin era, patients had to live with the symptoms of severe anemia, multiple transfusions, and frequent hospitalization. Recombinant erythropoietin (rhEpo) was approved in 1989 for the treatment of CKD anemia. Widespread use of Epo in the management of CKD anemia ensued. Over the past 2 decades, the market for Epo has dramatically increased. It is now estimated that $22 billion worth of Epo has been sold.^[2] This vast market opportunity has not gone without notice in the pharmaceutical industry, and many Epo analogues and derivatives have entered the marketplace. These newer Epos are now grouped under the term erythropoietin-stimulating agents or ESAs. In addition, follow-on epoetins (FOEs), similar to the innovator epoetin, are now commonplace, particularly in emerging countries.

Here is a review of EPO's structure:

Epo is an acidic glycoprotein with a molecular weight of 30.4 kDa (Table ).^[3,4]       

The carbohydrate part of the molecule (approximately 40%) is composed of 3 N-linked and 1 O-linked glycan moieties. N-glycans are key to the biological activity of Epo; the addition of N-glycans into rhEpo increases the carbohydrate content and results in prolonged survival of the molecule. From a structural perspective, Epo has a basic structure like other cytokines (eg, the interleukins). It is composed of 4 amphipathic {alpha}-helical bundles. There are 2 domains located on Helix C and Helix D that are necessary for binding to the Epo receptor (EpoR). Following binding to the EpoR, a JAK2-mediated signal transduction cascade ensues (Figure 1). Epo's binding affinity is also critical to its action. Epoetin-alfa has a high binding affinity, whereas newer derivatives such as continuous erythropoietin receptor activator (CERA) have much lower affinities that are thought to contribute to the longer half-life of these molecules...

In the years following the launch of rhEpo, it became apparent that N-linked glycosylation increased the half-life of the Epo molecule. In 2001, darbepoetin, a longer-acting derivative of epoetin-alfa, was approved. In 2007, CERA, a derivative of epoetin-beta, received regulatory approval. Both darbepoetin-alfa and CERA have a prolonged half life compared with epoetin-alfa or epoetin-beta (Figure 2); these agents have been extensively tested in phase 2 and 3 programs and allow less frequent dosing of Epo in the management of CKD anemia...

If it means something to you, CERA is pegylated EPO:

CERA is a pegylated form of epoetin-beta. CERA is a 60-kDa molecule, approximately twice the molecular weight of epoetin-alfa.^[12,13] A large methoxy-polyethylene glycol polymer is incorporated into the epoetin molecule, essentially doubling its molecular weight compared with epoetin. This modification markedly prolongs CERA's half-life in humans to about 135 hours. In addition, CERA binds to EpoR more slowly than Epo. These 2 attributes result in CERA triggering the JAK2 Epo signal transduction cascade without being internalized. Consequently, CERA has more sustained biologic activity. CERA has been tested extensively and can be used less frequently than epoetin-alfa or darbepoetin-alfa -- it can be administered either once every other week or once monthly.^[14-16]

If you are a anti-doping agency you will not be happy to read that different ways to stimulate EPO are on the way.

Small-molecule Epo mimetic peptides (EMPs) provide a novel paradigm to stimulate Epo. EMPs are peptide sequences that bind and activate EpoR. For example, Wrighton and colleagues^[25,26] have identified a 20-amino-acid peptide (GGTYSCHFGPLTWVCKPQGG) that binds EpoR and has both in vivo and in vitro biologic activity. An example of an EMP that has entered clinical trials with much promise is Hematide (Affymax Inc., Palo Alto, California).^[27] This is a pegylated dimeric EMP that has no sequence homology to Epo but binds and activates EpoR. PEGylation enhances the stability and prolongs the half-life of the molecule (t1/2 of up to 60 hours). Hematide is now being evaluated in phase 2 studies both in renal patients and in patients with cancer.^[28,29] Other EMPs are also in the pipeline.

EPO can be a very effective performance enhancing agent.  Given the advances in the molecular pharmacology of EPO, it will be a formidable task to prevent EPO abuse in sport.

Research shows EPO may improve cognitive functioning...but what about the short memories of doped athletes?

Interesting results from a medical trial at the Max Plank Institute found that cognitive functioning in mice improved with EPO, long abused by athletes for endurance tasks -- especially track and cycling.  EPO stimulates more blood cells allowing a greater capacity of the blood to unload oxygen in the tissues.  Apparently the drug, or a downstream affect of the drug enhances neuronal circuitry of memory functions.  To Barchester Healthcare News:

A drug which has been linked to athletics doping scandals may have positive effects on memory, according to a new study.

Research published in the open-access journal BMC Biology suggests erythropoietin (EPO) may improve memory due to a direct effect on neurons in the brain, as opposed to any effect it might have on blood production in the body.

According to scientists involved in the study, the findings could prove useful in the development of treatments for diseases which affect the brain, such as Alzheimer's and multiple sclerosis.

The researchers revealed that treatment with EPO appeared to "increase the number of inhibitory circuits, which actually increases the efficiency of transmission of excitatory nerve impulses in specific neurons, resulting in greater short-term and long-term plasticity in memory pathways in the hippocampus".

Could the beneficial effects of doping with EPO have also improved the cognitive functioning of athletes who abuse the drug?  Seems their memories fail them at times, especially when they try to recall their drug use.  Must be the hippocampus, huh?

Hannelore Ehrenreich, of the Max Planck Institute, compared the enhanced memory function seen in mice with the dramatic improvement in endurance and muscular performance experienced by athletes who have used the drug.

 

As Armstrong stages comeback, scientific controversy entangles report of his remarkable exercise capacity; Original author sarcastically defensive

For years Lance Armstrong and his lawyers pointed to a scientific study purporting to demonstrate Armstrong's incredible physiological advantage over competitors.  Now it appears the author of the study erred in the calculations.  Doping the study? 

Armstrong's physiological parameters were followed longitudinally by University of Texas scientists.  Using exercise physiology measures the scientists claimed Armstrong's training regimen produced an astonishing  improvement in his exercise efficiency.  There developed a hangup though -- they used the wrong formula in calculating one of the measures.

To the New York Times:

As Lance Armstrong prepared to announce his return to professional cycling this week, a scientific debate about his past was also rekindled.

In a letter to The Journal of Physiology posted online for subscribers on Monday, Edward F. Coyle, a respected human-performance expert with the University of Texas in Austin, acknowledged making an error in his long-term study of Armstrong’s muscle efficiency. The paper, which appeared in the same journal in 2005, has been repeatedly used by Armstrong and his lawyers to fend off allegations that his cycling success came in part through doping.

Three Australian scientists and one mathematician pointed out the error in a separate letter to the journal. The mistake involves one of the two ways Coyle calculated improvements in Armstrong’s muscle performance. The experts argue that the error effectively makes Coyle’s widely cited study invalid — a charge flatly rejected by Coyle, who called the error a minor miscalculation. But the somewhat arcane exchange has again raised questions about Armstrong and his record seven consecutive Tour de France victories.

It is a stretch to raise questions about Armstrong doping, simply because a scientist miscalculated the cyclists's exercise capacity.  However, the paper attempted to explain Armstrong's dramatic improvement after his treatment for testicular cancer.

Until his just-suspended retirement, Armstrong had experienced two distinct phases of his career. Before developing advanced cancer at 25, he was one of many talented professional cyclists. Rather than being seen as a contender at the Tour de France, he was better known for quitting the race early. But after returning to racing in 1999, he was virtually without a peer in his sport.

Skeptics have argued that such a dramatic transformation was impossible without doping. Armstrong has repeatedly denied ever doping.

Coyle’s 2005 paper provided a clear response to doubters. From 1993 to his comeback year of 1999, Armstrong was tested on a special stationary bicycle in Coyle’s lab in Austin, Armstrong’s hometown. That data, Coyle said in his paper, showed that Armstrong’s dramatic improvement largely came from a long-term increase in his muscle efficiency combined with weight loss from his bout with cancer.

Australian scientists, concerned about the miscalculations in the paper, even raised the possibility of scientific fraud.

“They were really concerned, on a scientific level, that Coyle had been able to perpetuate this myth that cycling efficiency changes,” he said. “I was more concerned, to be frank, about why all these alibis were suddenly being put under scrutiny and shown to be false.”

After raising a variety of concerns directly with Coyle about his research methods and, according to Ashenden, being rebuffed, the group lodged a formal complaint of scientific misconduct against him with the University of Texas.

However the Univ of Texas group was cool to the idea, and the paper's author was less than cool...he was rude.

In his letter, several e-mails and an interview, Coyle acknowledged his mistake. But he said that it did not change his overall findings about Armstrong’s gross muscle efficiency improvements. He called the calculation error “a minor variation” that “doesn’t make a practical difference.”

Coyle charged that the Australians had “more than unbiased science in mind” in their work.

Characterizing their complaints as an “attempt to confuse issues and raise doubt about obscure issues,” Coyle said that the Australians were attempting “to spin clouds of doubt about me, my paper and thus Armstrong.”

He added: “This is a minor waste on my time. However, I don’t understand how they can afford to spend so much time on this. Don’t they have real jobs?”

Quite a sarcastic remark from a guy who was just scientifically embarrassed.  Any time a miscalculation is discovered the paper should be recalled or rewritten, rather than insults hurled at those who question the mistake.  As the Times points out, independent reviewers also cast skepticism on the results.  Interesting to see where this all leads.

The Steroid Development Juiced League (Dominican Summer League) catches 4 more players horsing around

The Dominican Summer League players continue to pump steroids into their veins at an alarming rate.  Four more minor league baseball athletes today caught horsing around with Equipoise (boldenone).  No wonder fans look skeptically at Caribbean athletes when records are set. (The Morning Call)

Four minor league pitchers suspended for drugs: Four more players from the Dominican Summer League were each suspended 50 games for testing positive for banned performance-enhancing drugs under baseball's minor league drug program.

The four players suspended were all pitchers, with Arturo Florentino, Carlos Galvez and Jose Tineo in the Chicago Cubs system; and Michael De La Cruz of the Texas Rangers. They tested positive for a metabolite of Boldenone, a steroid.

Earlier this week four players from the DSL were named as juicers.

Chinese deception: Age doping, the new (old) frontier, now applied to Olympic gymnasts

"Doping" is cheating.  Cheaters can perpetrate the craft in any number of ways: bribers, drugs, ringers, rule violations, copying, plagiarizing, cutting corners.  The fight against doping and steroids in sports is the fight against cheating.

Guys who argue for legalizing steroids and other PEDs deserve respect, and deserve their opinions aired.  Why not?  Respect those opinions because they are not calling for cheating.  The drug cheats actually negatively affect those who wish to use PEDs in a legal way.

Apparently the Chinese government falls into the cheating category.  So craved for international attention, the Beijing bureaucrats can't have enough success naturally, so they rigged the ages of the women's gymnasts (Epoch Times on unearthing evidence).  As if no one could figure that out.  When the corruption is pointed out, the Chines government once again falls back on tried and true tactics of putting up smoke screens like 'American and Europeans are large because they use steroids', or 'Westerners can't tell the age differences between Asian youngsters".   Justice Anthony Kennedy noted...''Even a dog knows the difference in being stumbled over and being kicked.''

Time addresses 'age doping':

As much a fairy tale as the gymnastics competition has been for China, with the country snagging men's and women's team event golds and 14 of the 42 medals awarded in the sport in Beijing, the story may not have such a happy ending. Allegations that at least five of the six women's team members are younger than the International Olympic Committee (IOC) minimum age of 16 continue to fester, as documents with later birthdates for some of the girls have surfaced...

Under pressure to address "age-doping," the IOC asked the International Federation of Gymnastics (FIG) on Friday to re-open the Federation's previous investigation into the matter of the girls' ages. Prior to the competition, when rumors of the under-aged gymnasts first surfaced, the FIG had looked at the passports of the gymnasts and declared itself satisfied that the girls were at the lower-age limit of 16, not 14, as some earlier news reports on the girls had noted. Now, the FIG is asking the Chinese Gymnastics Association for further proof of the athletes' ages. The United States Olympic Committee also sent a letter to the IOC on Friday asking that the issue be resolved.

Be prepared for even more smoke screens.  One of the original muckrakers, Stryde Hax, addresses even more documents that implicate the duplicitous Chinese officials:

Cui Dalin, the vice minister of the General Administration of Sport of China, said He Kexin, the uneven bars Olympic champion, had moved from one team to another last year, and a wrong birth date was written on the registration forms for the new team.

“During the registration, there were some discrepancies in the age of the athlete, therefore that mistake has led to a series of misunderstandings afterward,” Cui said during a closing news conference for the Chinese sports delegation here. “I can say for sure the age of the Chinese gymnasts comply with the rules.”

I think we can all breathe easier now that officials are beginning to address the problems that so many have observed. However having spent some time studying the documents, I'm concerned about what I perceive to be a discrepancy. The alleged mistake led to at least three separate Excel spreadsheets, now deleted, showing a birthday for Kexin of Jan 1, 1994. This in itself is interesting. However my interest is in Cui's statement that the change occurred "last year". Last year was 2007, and as alert readers of this blog will recall, the Internet Archive has kept two copies of a document published to sport.gov.cn which establishes Kexin's birthday as 1-1-1994. The problem here is that the Internet Archive saved one of these copies in June of 2006, two years ago. Additionally, when the document was stored in the Internet Archive, the document contained a publication date of January 27, 2006. Neither of these dates is in the least bit consistent with Cui's statement.

Age cheating is as old as the hills.  We have seen parents, coaches, and officials cheat 10 year-old youngsters as they lie about age and geography of their children or players.   Frankly, these cheater should be crushed or they continue their corrupt miscreant ways.  Remember Danny Almonte's march to infamy as he humiliated 12 year-old Little League baseball players, which captivated the media?  Almonte downgraded his age, which is the usual age cheat.  Not so in gymnastics where younger means better.  No shame these age dopers.  Crush them.

Bicarb for the biceps: legal dietary supplement

Sometimes this steroid madness gets carried away...not by us of course.  A report from the London Times discusses sodium bicarbonate (Arm and Hammer, no less), the kind found in your kitchen.

Bicarb is a basic (as opposed to acid) substance that can neutralize lactic acid in the body.  Lactic acid is though to produce the muscle fatigue of exercise.  This article looks at new studies documenting the effectiveness of bicarb on exercise and recovery.  Reducing the lactic acid load should improve exercise recovery.  (I looked at this years ago for kids on the track team, but thought there would be no way kids would actually consume bicarb.)

Performance-enhancing drugs usually bring to mind designer steroids and human growth hormones. Yet some athletes rely on more rudimentary - and legal - means to boost their race times, including using a substance usually tucked away in a kitchen cupboard.

For years, keen runners have sworn that taking a spoonful of bicarbonate of soda (baking soda) helps them to keep going for longer. For years, experts doubted that there was anything other than a placebo effect to these claims until they subjected the substance to rigorous examination. Most exercise scientists investigating the trend for “soda-doping” among athletes and gym-goers have shown that it offers significant benefits for endurance and speed.

Like Michael Phelps's tunes, bicarb is not an illegal performance enhancer.  Bicarb counts as a dietary supplement.  Like pasta.

At Loughborough University, for instance, physiologists reporting in the June issue of the International Journal of Sports Medicine showed that swimmers who took baking soda about one hour before a 200m event were able to shave a significant time off their usual performances. Dr Jonathan Folland, who led the study, says that it is not uncommon for top swimmers to take sodium bicarbonate (another name for the substance) before a competition to give them an edge. Indeed, he showed that of nine swimmers tested, eight recorded their fastest times after ingesting a supplement of the common baking ingredient.

More after the jump

So Michael Phelps is doping...with Good Vibrations?

The Baltimore Sun runs a piece (unedited) commenting on Michael Phelps's unfair advantage before races: he rocks out (or raps out).  The thesis is that music enhances performance physiologically.  This is taking things a little too far.  Doesn't training increase oxygen utilization?  Should athletic training be banned as doping?  Here is the prelude:

I’m going to present our guest post today without comment, and Kevin, if you feel like opining, feel free.

Dr. Alexei Koudinov is the editor of the Israel-based Doping Journal Web site. When he sees Michael Phelps race, he sees a cheater. I asked him to explain why and he shared the essay you'll find below. He titled it, "Doping by the pool invalidates Phelps Beijing 2008 Olympic swimming gold, world records."

And here we go to the guest post:

Did you notice that Michael Phelps wears earphones and is listening music just before his every Olympic start, at Beijing’s Olympiad Water Cube pool deck...he was the only swimmer who worn earphones at the pool deck. Intriguing scientific evidence testifies: Listening to music improves blood oxygen capacity and is a performance enhancement.

There could be several mechanisms, says Stefan Koelsch of Max Planck Institute for Human Cognitive and Brain Sciences, in Leipzig, Germany, who has published 40 articles on the subject of how the body reacts to music. Dr. Koelsch says that "music can have influences on the breathing rate (e.g. via emotional effects such an increased arousal) which will alter oxygen levels in the blood, or relaxing effects (so that fewer muscles consume oxygen, which also increases oxygen levels)." He says that his group "has reported clear changes in breathing rate on a conference last year, with breathing rate being higher during pleasant music." In line with Koelsch conclusion are the data of the research article by Luciano Bernardi group of the University of Pavia, Italy, implying that the withdrawal of music shortly before the swim race induces relaxing effects noted by Koelsch.

If I were a swimmer I would mimic anything Michael Phelps did including sticking my finger up my nose...

Evidence comes from the research done with human infants. It showed that music causes better saturation of hemoglobin with oxygen (a so-called SPO(2) parameter, compared with control subjects receiving no music, indicating an "enhancement of oxygen transfer") and that increased by music, oxygen saturation returns to the baseline faster compared with control, making it hard to detect the transient oxygen saturation shortly thereafter. While Koelsch preferred his own explanation on how music can improve body oxygen capacity, Dr. Alexander Cherniak, a researcher at the Chuchalin Pulmonology Institute of Moscow, Russia agrees that medical experimentation with infants allows good standardization of the research protocol, appropriate statistics and could be projected onto the adults.

Actually one cannot project infant research onto adults.  Different population, dudes.

So what? Can one call listening to music shortly before entering the swimming pool for competition a performance enhancement? Yes, say both Koelsch and Cherniak. If so, how long could this enhancement last? "Duration [of the effect is] not certain, from seconds to minutes," adds Koelsch. Beijing Olympic and world records by Phelps fall into the expert’s projected time frame. Yes, testifies Dr. Vance Bergeron, of Ecole Normale Superieure de Lyon, Laboratoire de Physique in Lyon, France: "[M]usic next to the swimming pool, less than 2 minutes before the start could indicate performance enhancement because of transient increase of blood oxygen capacity."

Bergeron adds that such a performance enhancement is "a bio-chemical feedback mechanism from an external source. The external source in the present case, music, is available to everyone, not harmful to the athlete or his peers, and carried out under full disclosure, hence I do not see how this conflicts with fair play and honesty," but says that "I am not an expert on the World Anti-Doping Agency (WADA)."

If the other athletes are allowed ear buds, then they should utilize the tunes too.  Tunes for the good vibrations...

Pheonix connecting dots between anabolic steroid use and suicide

Be careful with any interpretation of this, but a Phoenix medical clinic is under investigation following 3 patient deaths given anabolic steroids. ( KNXV-TV)

All three men have at least two things in common, they were taking steroids and they were getting them at Revolution Medical Centers, a Phoenix-based clinic that's currently under state and federal investigation.
 
"We're looking to see if there is a causal relationship between the death and the treatment or therapy they were being given," said Dr. Craig Runbeck, executive director, Arizona Naturopathic Physicians Board of Medical Examiners.
 
"You're hitting your body with a biochemical sledge hammer and you're pushing things way beyond where they were designed to be," Runbeck said.
 
The autopsy reports make no mention of anabolic steroids, but police reports and medical records do.
 
"Patients die everywhere," said Dr. Jeremy Bula, owner of Revolution Medical Centers. "They didn't die as a result of anabolic steroid use."
 
But one patient left behind a note.  "Stop using steroids. They will destroy your life or anyone with you," the note said.  Moments later, Brian Stubstad committed suicide.

A completed suicide is usually a very complicated multi-factorial act.  No one should point a finger at one particular cause.  However, it is true that anabolic steroids can be mood altering -- this is indisputable.  Is the use of anabolic steroids necessary and sufficient to produce an act of violence?  Probably not in most cases.  Can the use of AASs be contributory.  Absolutely....in a vulnerable person.  (Anabolic steroids are now a major drug of abuse; medical clinics are developing withdraw plans for users)

According to documents obtained by ABC15, he was a patient at Revolution Medical Centers for two years.  His chart indicates he had taken trembolin, a powerful steroid that's not approved for human use.

"Anytime you use a drug that's not approved for human use, there are unknown side effects," Runbeck said.

Was Brian Stubstad speaking from the grave?  According to medical records, he was complaining of depression and mood swings shortly after receiving steroids from Revolution Medical Centers.  In the weeks leading up to his suicide, there were police reports, a pattern of violence, and even an order of protection alleging death threats.

"The story sounds very familiar," said Don Hooton, whose son Taylor began using anabolic steroids five years go.  Six months later, 16-year-old Taylor was dead.  "He was going through severe mood swings," Hooton said. "It went far enough that he went upstairs, took two belts and hung himself."

 

Scientific views on doping

We present the links to recent scientific pieces on doping in sports.  These articles take some time to analyze, and thus no analysis from us right now, because franklyy we aren't smart enough.

1.  The Canadian Medical Association editorial.

It is almost 20 years since the Ben Johnson scandal at the Olympics in Seoul, Korea, drew attention to the issue of doping. Have we made progress since then in addressing this important sport and public health concern? Will the Olympic ideal survive, or will it be lost in a sea of hormone, steroid and stimulant abuse...

Athletes are now competing on an Olympic stage. Some performances may be suspect and proven to be illegitimate. But the overwhelming majority of athletes will compete fairly and cleanly. Sadly, their accomplishments are sometimes overshadowed by the debased conduct of a minority. Athletes from Canada and from other countries are the product of sport systems that work tirelessly to address the doping scourge. 

Antidoping programs in an Olympic setting ensure fair play and maintain public trust. A concern for drug use in community sport is equally important; the implications of such behaviour compel thoughtful, strategic interventions to ensure sporting integrity and public health.

2.  Donald Berry in Nature says that the anti-doping  labs are going down the wrong path.

In my opinion, close scrutiny of quantitative evidence used in Landis's case show it to be non-informative. This says nothing about Landis's guilt or innocence. It rather reveals that the evidence and inferential procedures used to judge guilt in such cases don't address the question correctly. The situation in drug-testing labs worldwide must be remedied. Cheaters evade detection, innocents are falsely accused and sport is ultimately suffering.

3. Nature editorial writers, agree.

Nature believes that accepting 'legal limits' of specific metabolites without such rigorous verification goes against the foundational standards of modern science, and results in an arbitrary test for which the rate of false positives and false negatives can never be known. By leaving these rates unknown, and by not publishing and opening to broader scientific scrutiny the methods by which testing labs engage in study, it is Nature's view that the anti-doping authorities have fostered a sporting culture of suspicion, secrecy and fear.

Detecting cheats is meant to promote fairness, but drug testing should not be exempt from the scientific principles and standards that apply to other biomedical sciences, such as disease diagnostics. The alternative could see the innocent being punished while the guilty escape on the grounds of reasonable doubt.

4. However, The Questionable Authority begs to differ about exposing all the pimples and warts...the charlatans will develop a blueprint to beat the testers.

From Berry's article:

Whether a substance can be measured directly or not, sports doping laboratories must prospectively define and publicize a standard testing procedure, including unambiguous criteria for concluding positivity, and they must validate that procedure in blinded experiments. Moreover, these experiments should address factors such as substance used (banned and not), dose of the substance, methods of delivery, timing of use relative to testing, and heterogeneity of metabolism among individuals.

In an ideal world, this is exactly the way things should work. Unfortunately, we don't live in an ideal world. There's a very real problem that will arise if the exact methods and criteria are publicized. As the folks at Nature point out in their editorial, there is an intense ongoing arms race between the people who make the drugs and the people who design tests. If the exact testing criteria are publicized, the drug makers will know exactly what they need to do to beat the tests.

That's a problem, and it's not an insignificant one.

If you provide all the testing details, it will stimulate the development of new methods for evading the testing, and make it much more difficult for the testing to achieve its goal. If you don't provide assurances that the testing methods are objective and reliable, it will continue to inject elements of distrust and paranoia into athletics. It's a delicate problem.

5. In another post, Mike Dunford takes on the Berry article on practical validity.

To put it another way, if the A and B samples both test positive for the same substance, there's very, very little chance that it's the result of anything other than something that is actually in the sample. At this point, the question becomes somewhat different - are the markers that the test looks for conclusive proof that a banned substance has been used? If they're not, they shouldn't be used in tests that can break someone's career.

That last is a harder question, and it's one where there really is the need for much more scientific examination of the testing procedures, as well as much more openness on the part of the testing authorities. That concern is very valid, and should be addressed. But on the whole, things are not as grim for athletes as Berry's article implies.

6.  A comment on The Questionable Authority concludes this:

After reading your comments, it seems that Berry's analysis is much more than misleading, it's downright wrong.

My understanding of Landis' number is: T/E ratios in normal folks are about 1:1. It takes a ratio of 4:1 to be guilty (so figure that includes 99.5% of folks). Landis was 11:1.

If 4:1 is 3 standard deviations, 11:1 is likely in the neighborhood of 12 standard deviations. To get this far away from normal without cheating would be a medical 'miracle'.

I'm not saying that it couldn't happen but you would think that something so extreme would have shown up in at least one of the numerous other samples he's given over the years.

                                 Posted by:                                  David C. Brayton  |                                  August 11, 2008  8:26 PM

    

Daily Steroid Injection

1.  The IOC delays decision on Greek sprinter Katerina Thanou in the Beijing Olympics.  Thanou filed an ethics complaint last week. (Fox Sports)

2.  New Zealand lifter says drugs integral to that sport.  (Telegraph)

Weightlifting's drug-tainted image has become an "accepted part" of the sport that clean athletes have to ignore, according to New Zealand Olympic lifter Richard Patterson.

3. Special issue of European Journal of Mass Spectrometry 'celebrates' Olympics dope testing including SARMs.  (Proteomics)

4. Amino Vital fuels USA athletes.  (Market Watch)

5.  The Olympics too seedy for sports wagering.  (Las Vegas Sun)

Gene doping at the Olympics: be afraid, be very afraid

On the eve of the Olympics, the Times Online ran a story looking at disconcerting trends developing in the doping world.  Numero Uno on this list was the offer of 'gene doping' (actually stem cell doping) by a Chinese physician at a Chinese hospital.  (sports stem cell doping may be the second best use of the technology)

Startling new evidence of a burgeoning underground doping culture in China emerged last night as a hospital doctor said that he was prepared to give illegal performance-enhancing gene therapy treatment to an Olympic swimmer. The doctor was caught on camera by a German television investigator saying that he wanted £12,000 for a two-week treatment that would help to strengthen the lungs of a fictitious American swimmer.

The opening paragraph refers to gene doping, however the German story develops more aspects of illicit sports doping for 2008:

The documentary, broadcast by ARD on Germany’s main channel last night, went on to show evidence that drugs firms in China are prepared to sell steroids that have not passed full clinical trials, as well as erythropoietin (EPO), the blood-boosting drug, at a price far cheaper than in the West. In the case of one steroid, 100g was sold for €150 (about £120) when the price in Europe would have been more than €6,000.

...With the Olympics beginning in Beijing in a little more than two weeks, the documentary evidence of cheap, on-demand gene therapy alarmed David Howman, the director general of the World AntiDoping Agency (Wada). “This is worse than my worst fears,” he said.

When the head of a hospital gene therapy department in China was approached by a fictitious American swimming coach seeking stem-cell treatment for one of his swimmers, the doctor replied: “Yes. We have no experience with sportspeople here, but the treatment is safe and we can help you.”

That's doctor in whom to entrust confidence:  "no experience with sportspeople".

Asked how it would work, the doctor said: “It strengthens lung function and stem cells go into the bloodstream and reach the organs. It takes two weeks. I recommend four intravenous injections . . . 40 million stem cells or double that, the more the better. We also use human growth hormones, but you have to be careful because they are on the doping list.”

And the price? “Twenty-four thousand dollars,” the doctor said.

Ouch, expensive, but then again swimmers spend 100,000 in trainers and coaches.  Here is a paragraph from a consensus panel of international experts on the "Molecular basis of connective tissue and muscle injuries in sport "

[Arne Ljungqvist, Martin P. Schwellnus, Norbert Bachl,et al, Clinics in Sports Medicine,  27, Pages 231-239 (Jan 2008)]

Mesenchymal stem cells are adult tissue-producing cells that have been isolated from various parts of the body, including cartilage, bone marrow, synovium, adipose tissue, articular cartilage, muscle, and tendons ^{[70], [71], [72]}. Potentially, mesenchymal stem cells can be used for tissue-engineering strategies through implantation of scaffolds and gels, for gene delivery, and for production of growth factor to stimulate tissue repair or inhibit tissue degradation ^{[73], [74], [75]}. Most studies have been conducted in animal models. Some studies of human bone, cartilage, and tendons have produced positive results ^{[76], [77], [78]}. Further controlled clinical trials in musculoskeletal injuries in humans are warranted, however. Reasons for the lack of progress in this field include the need to find the optimal sources of and methods for the differentiation of cells and for the development of optimal surgical delivery materials and methods ^{[79], [80]}. Although some studies have shown negative effects, including ectopic calcification and connective tissue overgrowth [78], further clinical trials should be undertaken to determine whether long-term complications exist.

The Chinese doctor appears to have the protocol down a little better than one would think after reading the paragraph above.  How did this happen?  If practiced would the protocol lead to serious complications or death?

Will the 2008 Olympics be the first to see 'stem cell doping'?  (more later)

Ode Magazine piece misses the mark on doping

A piece in Ode Magazine starts off asking about the role of society vis a vis the Tour de France doping.  Unfortunately by the third paragraph the article drifted astray -- way astray.

If a conclusion is drawn it should be ascertained from the valid data preceding it.  Let's take a look:

I just read the news about the third doping case at this year's Tour de France: Italian rider Riccardo Ricco has tested positive for the banned blood-booster EPO. And of course, as it happens so often with sportsmen who are associated with artificial performance-enhancing measures, Ricco was "booed by spectators when he was taken off the Saunier-Duval team bus by police Thursday," the AP report said.

Poor Ricco! I don't think using drugs was such a great idea, but I do feel we need to ask ourselves some serious questions before we condemn him. After all, in the rest of society, performance-boosters have become increasingly commonplace.

OK, now here it comes, the litany of horrible pharmaceutics:

* People take Prozac so they can better manage psychological pressure. * Students take Ritalin to improve their grades. * Middle-aged men take Viagra to spice up their sex lives. * Shy people take Paxil so they can handle social situations. * Writers, musicians and other artists take other stimulants to stand out in their fields.

Cliche list.  Inaccurate information.

• Prozac is not prescribed 'to manage psychological pressure'.  Fluoxetine is prescribed for mood disorders, anxiety disorders like OCD, Autism, and other medical disorders. The key is 'disorder'. The diagnosis 'psychological pressure' will never be found in a medical record.
• Students do not take Ritalin to improve their grades.  Methylphenidate is prescribed for patients with ADHD to ameliorate inattention, impulsivity, and hyperactivity.  An improvement in grades may be a benefit with the appropriate work effort.
• Middle aged men do not take Viagra 'to spice up their sex lives'  (what an incredibly insensitive remark).  Viagra is used for impotence -- the inability to achieve an erection.  "Spice up".  Yeah, We suppose crutches are used by amputees to beat the airport rush.
• Shy people take Paxil so they can handle social situations.   There's an example of an egregious abuse of drugs. huh?  Patients with social anxiety are clearly cheating the system and should simply stay isolated at home.
• Writers etc. tale stimulants to stand out in their field.   Huh?  Ok, you lost us at 'stand'

Seems this writer distorts medicine, or twists medical treatments to support a illogical argument that EPO abusers like Manuel Beltran is paying for the sins of the Prozac Society.

And Marion Jones took insulin mimicking those horrible diabetes who inject insulin so they can eat pizza...

In modern society, athletes have become heroes. Sports stars aren’t so much role models for society as reflections of it, albeit reflections with exceptional talent. Athletes take performance-enhancing substances mainly as a consequence of our sky-high expectations and the huge commercial interests involved.

Ultimately they are part of the same achievement-oriented society we are, in which he use of stimulants has become normal. The appropriate response is not moral outrage, but a relaxing of the enormous pressure we put on them: Just do your best, kid. That’s all you can do.

OK, we understand the conclusions; however please present preceding arguments developed to support the conclusions rather than a roll call of popular press target medications.

PEDs, and medicines are simply molecules.  Molecules are not evil.  The use or abuse of the molecules is the issue.

Daily Steroids Dose

1.  Univ of Penn scientists use mice to look at blood doping markers.  (Trading Markets)

2.  Steroid scandals hurt the value of baseball cards.  (The Town Talk)

3.   Is using baking soda before a race considered doping?  (Medical News Today)

4.  Should Jason Giambi be an 2008 MLB All-Star?  (Coffee Sitter)

5.  Todd Williams, included in the Mitchell Report. tries to make it back to MLB.  (Baltimore Sun)

EPO doping tests questioned: Just when you thought it was safe

A very disturbing New York Times piece cited research to be published in Blood (oops goofed that one up) the Journal of Applied Physiology, that questioned the effectiveness of EPO testing.  Give 8 athletes EPO and how many will test positive: ZERO (this is wrong; Lab A found all 8 tested positive for EPO; Abstract here).  It looks like the Times did not exactly get the analysis correct.

Athletes who want to cheat by injecting themselves with a performance-enhancing drug that boosts their blood cell count can do so with little risk of getting caught, a new study indicates, possibly exposing another flaw in what is regarded as the world’s toughest anti-doping program.

A urine test that is supposed to detect the drug, and that will be used in the Tour de France next month and in the Olympics in August, is likely to miss it, the study says. The substance, recombinant human erythropoietin, known as EPO, stimulates bone marrow to speed up production of oxygen-carrying red blood cells. And with more blood cells, endurance athletes like cyclists and distance runners can perform better.

"Likely to miss" EPO doping is like saying we are all likely to run at a speed a bit less than the speed of light.

We know Marion Jones used EPO, and was only positive on an 'A' sample.

Although athletes have said EPO is in widespread use, few have tested positive. Most of the athletes who have been linked to doping in recent years have been caught not through drug testing, but rather through criminal investigations. In the August 2006 issue of the journal Blood, the American lab accredited to conduct EPO testing reported only 9 positive tests out of 2,600 urine samples.

The new study may help explain why: the test simply failed.

Oh yeah, the test failed...spectacularly in Lab B if the Times is to be believed.  However when we read the study, actually Lab A found all 8 EPO users to be positive, and Lab B found 7 samples to be 'suspicious'.

The study, to be published Thursday in the online edition of the Journal of Applied Physiology, was conducted last summer and fall by a renowned lab in Denmark, the Copenhagen Muscle Research Center. The investigators gave eight young men EPO and collected urine samples on multiple occasions before, during and after the men were doping. The men’s urine samples were then sent to two labs accredited by the World Anti-Doping Agency, and EPO tests were requested.

The first lab found some samples positive and a few others suspicious. (A suspicious result does not bring sanctions for doping.) The lab also declared a sample positive, although the man had stopped taking the drug and it should have been gone from his urine. His previous urine sample, obtained when he was taking EPO, was negative in this lab’s test.

The second lab did not deem any urine sample positive for EPO and found only a few to be suspicious. The two labs did not agree on which samples were suspicious.

The anti-doping agency’s rules say that if an athlete’s urine shows traces of EPO, it must be tested again by a different accredited lab. The athlete is declared guilty of doping only if the second lab also detects EPO. By that rule, none of the subjects would have been charged with using EPO, even though their red blood cell counts rose and their performances on an endurance test improved.

Dr. Don Catlin uttered a conservative invective.  Something along the line of '*#@&%@# that worthless test" would have been more appropriate.

“The paper certainly is an eye-opener,” said Don Catlin, the chief executive of Anti-Doping Research, a nonprofit group in Los Angeles. “It’s quite remarkable.”

Charles Yesalis was a bit more pessimistic:

The findings in the latest study should be no surprise, said Charles E. Yesalis, a professor of sports science at Pennsylvania State University. For decades, he said, anti-doping authorities have claimed they have tests that work and for decades athletes have been taking drugs without getting caught.

The anti-doping authorities, he said, “remind me of little boys whistling in the graveyard.”

So here is where we are at with weeks to go before the Tour de France and the Beijing Olympics: the EPO doping test appears to be an utter failure at detecting EPO doping.   Disconcerting.

Viva Viagra: A rise for athletic peak performance or an impotent placebo?

Is Viagra getting top athletes up for peak performance?  Or is ithe  frug one more impotent PED placebo sham?

Recent stories concerning the use of Viagra by multi-drug cheat Roger Clemens and others raises the question: Does Viaga stimulate athletic performance?  The drug could be a legal PED as WADA does not prohibit sildenafil as a performance enhancing drug.

A new story by the Times Online looks more at the potential of sildenafil citrate -- Viagra -- to get athletes up and going for competition.

Athletes are turning to a new performance enhancing drug: Viagra. Traces of the drug, which is intended to alleviate sexual dysfunction, are increasingly appearing in the testing of samples from sports competitors.

It has become so widespread that the World Anti-Doping Agency (Wada) is considering whether to include Viagra in its list of substances banned in international sports.

Christiane Ayotte, head of a Wada-accredited laboratory in Montreal, said she regularly identifies Viagra and Cialis, a similar product, in the urine of male sports competitors. No action is taken because it is not illegal.

“Each time there is a seizure of banned drugs you can be sure that there’s Viagra and Cialis found as well,” she said.

The New York Daily News said this about Viagra:

Roger Clemens, whose claims he never took steroids are under federal investigation, has apparently discovered the benefits of another performance-enhancing drug sweeping the sports world - Viagra.

Clemens stashed the clearly marked, diamond-shaped pills in a GNC vitamin bottle in his locker at Yankee Stadium, according to a source familiar with the clubhouse, perhaps keeping the drug undercover to avoid the inevitable wisecracks about all the girlfriends he needed to please.

The Telegraph makes claims for the drug's benefit in both explosive and endurance sports -- like sprinting and cycling:

Experts believe Viagra could help in events requiring explosive power, such as sprinting. The drug works by dilating blood vessels allowing more blood to reach the penis. This action could also allow more oxygen and nutrients to reach muscles.

Other experts suggest the drug, which allows couples to have longer sex sessions, could also help with endurance sports, like marathons and cycling.

Don Catlin, an American expert on doping, said he had suggested several years ago that Viagra could be used to enhance athletic performance.

"I thought there was some reason to be concerned about it and to put it on [Wada's banned] list," he told the Sunday Times newspaper.

A study of cyclists who took sildenafil citrate (the scientific name for Viagra) while racing at altitude found it reduced their time over 6km by 15 per cent.

PED 'expert' Victor Conte endorses NO enhancers (as noted in the comment below):

Victor Conte, who ran the Bay Area Laboratory Cooperative in San Francisco and supplied banned substances to top competitors, such as Marion Jones and Dwain Chambers, the runners, has claimed of Viagra: “All my athletes took it. It’s bigger than creatine [a legal muscle-building supplement]”.

There may be another reason athletes are taking Viagra – to compensate for the impotence brought on by using banned hormones.

Ya gotta get up for Victor Conte endorsement, eh?

(more after the jump including Viagra studies at the University of Miami)

Growth Hormone: New biomarkers, and calls for more regulation

First we go to News-Net Medical for a report on the search for new biomarkers, that may be useful in the anti-doping crusade.  Investigators have been looking at proteins that change when exogenous HGH is administered.  Biomarker detection would aid a regulatory agency like WADA when trying to detect drug cheats l ike Marion Jones, who abused HGH on the way to her discredited Olympic medals.  (Update: The debate about the performance enhancing effectiveness of HGH continues on)

Researchers have found potential new biomarkers for growth hormone, which they say could help the sports community in detecting growth hormone abuse. The results of the animal study will be presented at The Endocrine Society's 90th Annual Meeting in San Francisco.

Many athletes are misusing recombinant human growth hormone, a drug intended for people who are growth hormone deficient, because of its supposed ability to decrease fat and increase muscle. However, detection remains a challenge. The growth hormone drug appears only briefly in blood and is identical to the growth hormone that the body naturally makes, said study coauthor John Kopchick, PhD, of Ohio University.

"Variability is a problem with current testing for growth hormone doping," Kopchick said. "It is gender and age-sensitive. We're looking for a test that will give standard results for everyone."

The authors are attempting to identify proteins in the blood that could be biomarkers for growth hormone action. A biomarker is a substance that can be detected in higher-than-normal amounts in the blood, urine, or body tissues and thus could be used for screening.

A bookmarker would alert authorities that doping has occurred.  For instance the decrease in LH seen when testosterone is administered would be considered a biomarker.

Kopchick's group injected six male mice with growth hormone once a day for a week and also injected six male mice with saline, to serve as controls. On the eighth day they determined the protein changes in the blood of all mice.

Several proteins or their isoforms (genetic variants or protein sub-populations that are modified differently) greatly increased or decreased in the growth hormone-treated mice, compared with controls, the authors reported. They included transthyretin, clusterin, albumin, and apolipoprotein A-1 (apoA1).

If the results translate to humans, these proteins have the potential to be new biomarkers for growth hormone action, according to Kopchick. Regulatory agencies could use new biomarkers for growth hormone in their attempts to halt the abuse of this drug among athletes, he said.

"Extension of these results to humans is of paramount importance, and these studies are ongoing," he said.

The second report originated with a paper in the Journal of the American Medical Association, where Dr. Thomas Perls describes the huge anti-aging industry's use of HGH.  Dr. Perls will point out that HGH use in Anti-aging is entirely unresearched, and potentially dangerous.  To Science Daily:

Since their previous article in the Journal of the American Medical Association (JAMA) in 2005 on the clinical and legal aspects of growth hormone for anti-aging, in which researchers from Boston University School of Medicine, Boston Medical Center and the University of Illinois at Chicago alerted the medical community and lay public to the deceptive mass marketing and illegal distribution of growth hormone for anti-aging and athletic enhancement, the authors provide new evidence demonstrating that these deceptive and dangerous activities have grown worse.

Remarks Dr. Thomas Perls, Director of the New England Centenarian Study and an associate professor of Medicine at Boston University School of Medicine, who has monitored the anti-aging industry for over the past ten years, "despite the overwhelming evidence that the risks and dangers of growth hormone far outweigh the clinically demonstrated insignificant benefit in normally aging individuals, the prescribing, distribution and sale of hGH for alleged anti-aging aesthetic and athletic enhancement has dramatically grown over the past few years. Clearly, the coordinated and aggressive marketing campaigns of the anti-aging and age-management industries are highly and most unfortunately effective."...

Contrary to published claims, neither long-term safety nor health benefits have been demonstrated in normally aging individuals taking hGH. A review of clinical studies among healthy, normally aging individuals found that hGH supplementation does not significantly increase muscle strength or aerobic exercise capacity. However, documented adverse effects include soft tissue edema, arthralgias (joint pains), carpal tunnel-like syndrome, gynecomastia (enlarged breasts) and insulin resistance with an elevated risk of developing diabetes. Increasingly more and more animal and laboratory studies suggest an increased cancer risk.

Dr Perls came up with the following recommendations:

The authors suggest that several measures need to be taken to address the inappropriate distribution and use of hGH.

Among their recommendations:

• The public must be accurately informed by physicians and scientists who do not have a vested interest in hGH, about health risks, fraudulent marketing and illegal distribution of this drug.
• Organizations that promote or indirectly profit from the medically inappropriate and illegal distribution of hGH that have been accredited by the Accreditation Council for Continuing Medical Education (ACCME) to offer American Medical Association Physician Recognition Award (PRA) category 1 CME credits or other categories of CME credit should, at a minimum, have their accreditation revoked.
• U.S. manufacturers of hGH must be more effective in, and held accountable for, controlling the distribution of the drug to companies providing the drug for illegal uses.
• Congressional hearings and media attention surrounding hGH should focus less on athletes and prominent entertainers who are also victims of deceptive marketing and pushing of hGH, and much more on the distributors who are violating federal and state laws by making the drug available for non-approved uses.

Daily Steroid Briefing

1.  Is Bowser or Spot ingesting steroids in pet food?  (Natural News)

2.  Interesting story from India:  Renegade doctor disguised steroids as 'turtle blood'; patients felt immediate boost.  (MedIndia.com)

3.  Researchers find that old muscle cells inhibit cell regeneration by producing a chemical called "TGF-beta".  Modulating stem cells reversed aging on older muscle.  (Technology Review)

4.  More animal stories: Don't give those Greyhounds any more anabolic steroids. (AzStarNet.com)

5. Steroid user (along with meth, coke, maryjane, and other drugs) wanted to kill OKlahoma prosecuting DA.  (News Examiner-Enterprise)

Daily Steroid Briefing

1.  Marion Jones's teammates to lose Sydney medals; whose crying now.  (AFP)  (How about the San Francisco Giants?)

2.  Michigan's Mario Manningham played 'high'.  The state of NCAA drug testing.  (Freep)

3.  It's all about winning in the USJCA  (US Jock Culture of America)(USA Today)

4.  Scientists admit to cerebral bench-presses and brain PEDs.  (Breitbart)

5.  Cockfighters bribed lawmaker.  [post your own pun here].  (Knoxnews)

6.  New York City cops to submit to steroid tests.  Start boning up on those Tyler Hamilton excuses.  (NY Daily News)

7.  Which celebrities juice? (Cracked.com)

Studies suggest anabolic steroids produce long term changes in muscle structure

The Wall Street Journal dug up an interesting study from Umea University.  The study from the Department of Integrative Medical Biology at Umea (Sweden) demonstrated long term muscle changes in anabolic steroids users -- despite current abstinence.   The WSJ related these changes to MLB stats. (here)

In the study, which was completed in October 2006 by the Department of Integrative Medical Biology at Sweden's Umea University, researchers took muscle biopsies from 26 elite powerlifters who have competed at the sport's highest levels. Ten of the volunteers said they were not steroid users, but the other 16 had either admitted using these drugs in the past or said they were currently using them. Not only is it unusual for scientists to study elite athletes of any kind, it's almost impossible to study top athletes who are using steroids in competition.

When the researchers looked at the subjects' muscles through a microscope, they made a surprising discovery: Rather than returning to their original proportions, the muscles of the steroid users who'd stopped taking the drug looked remarkably similar to those of the subjects who were still using. They also had larger muscle fibers and more growth-inducing "myonuclei" in their muscle cells than the nonsteroid users.

The Journal says the study was published at the U of Umea's website, however this may be the journal abstract.

Interesting that anabolic steroid use increases muscle fiber size, and increases myonuclei number.  Perhaps this priming effects on muscle cells produces not only acute effects to enhance strength, but also enhances the use of HGH later in 'abstinent steroid users' (or concurrent users) as noted in this study.

Strength, peak power output and IGF-I significantly increased and total protein, albumin and free tetra-iodothyronine significantly decreased compared to controls (p < 0.05) and within the GH group (p < 0.017). Fat-free mass index and VO₂ peak significantly increased, while body fat and thyroid-stimulating hormone significantly decreased within the GH group (p < 0.017). Conclusions: Short-term rhGH increased strength and power. Of therapeutic value is the possibility that muscle bulk and strength could be increased in patients with muscle-wasting conditions.

Thus, one of the reasons administering HGH to college students does not enhance strength -- their muscle cells are not previously primed with AASs.  Charles Yesalis understands this:

Charles Yesalis, a former strength coach and professor emeritus of health policy and administration at Pennsylvania State University, says athletes who continue to train can retain as much as 85% of their gains from using drugs. This isn't based on muscle biopsies or peer-reviewed research, he says, but on 30 years of experience with athletes. He says he has talked privately with hundreds of dopers, some of them champions, and has seen the permanent benefits of performance-enhancing drugs. "These things are like rocket fuel," he says.

Good steroids, bad business, big Barry Bonds: Tammy Thomas trial touches on THG

Testimony in the Tammy Thomas-BALCO perjury trial turned to basic business yesterday.  And talked your basic Barry Bonds too.  Bonds, Marion Jones, and Jason Giambi received huge bang for their bucks according to testimony.

Patrick Arnold -- who has to know about as much about anabolic steroids as anyone on the planet -- and his ex-girlfriend talked to the jury.  Kelcey Dalton confided that Arnold gave his then-undetectable AAS -- the Clear -- to athletes including Marion Jones, CJ Hunter and Barry Bonds.  However as adroit as Arnold appeared in synthesizing steroids, he appeared clumsy in business acumen.

"Here's the thing: the stuff was so strong, man," said Kelcey Dalton, who helped market the substances developed and manufactured by Patrick Arnold, her then-boyfriend.

Arnold, a chemist, invented some of the steroids at the heart of a drugs and sports scandal in which Thomas is the first person being tried.

Dalton, testifying on the third day of Thomas' trial, said Arnold told her that athletes and trainers were reporting in the early 2000s they would use "really minute doses" of the steroids because doing so would minimize side effects, and "because they were so strong."

Holding her thumb and forefinger three inches apart to represent a small vial, Dalton said such a container would fetch $10-$20. "Marion Jones split it with C.J. Hunter and it lasted six months," Dalton said, referring to the track and field stars later disgraced for doping.

The sums of money Arnold was making were "very low," she said. "I think we should have charged more."

Considering the results that THG produced -- world records in the 100M dash, many Olympic gold medals, single season and career MLB home run records -- these were bargain basement prices.

Previous reports indicated Arnold re-discovered norbolethone (Genabol), a previously Wyeth synthesized AAS.  When this drug became detectable he synthesized Tetrahydrogestrinone, or THG

...chemical modification of gestrinone, a drug used in Europe to treat a gynecologic condition. THG also is very closely related to trenbolone, a controlled substance used to bulk up cattle.

Many of the finest people allegedly used THG: Barry Bonds, Gary Sheffield, Jason Giambi, Marion Jones, Tim Montgomery, CJ Hunter, & Kelli White.

Dalton suggested as much:

During her testimony, Dalton also said she heard Bay Area Laboratory Co-Operative founder Victor Conte say he had provided steroids to Jones, imprisoned earlier this month for lying to investigators about doping and her role in a check-fraud scheme; and to home run king Barry Bonds.

(more after the jump)

PSU Prof Yesalis and "Game of Shadows" authors Williams and Fainaru-Wada on steroid panel at Penn State; Yesalis says 95% of NFL players use HGH

Steroids expert and Penn State prof Charles Yesalis, and "Game of Shadows" authors Lance Williams & Mark Fainaru-Wada shared a stage in State College PA to discuss steroids and PEDs.  Report here (Pittsburgh and Tribune-Review) here(PSU Collegian), and here (personal blog).  In a startling statement Dr. Yesalis stated that 90-95% of NFL players used HGH (and PEDs).

The title of a Penn State roundtable last week -- "Steroids and baseball: Where is the public interest?" -- spoke to a societal split on the subject.

Authors Mark Fainaru-Wada and Lance Williams, whose 2006 book "Game of Shadows" exposed baseball's steroids problem, and two Penn State professors spent two hours probing the issue. Rules of the legal, moral and ethical kind have been broken by steroid-users, yet two years after the book's publication, and with steroid-use revelations continuing in baseball and other sports, there are those who don't even consider using performance-enhancing drugs as cheating.

"It is unquestionably cheating," Fainaru-Wada said, addressing the competitive question. "They are banned for a reason. They work."

Interesting observations that fans under-4o don't consider the use of PEDs as 'cheating'.

"The notion of an athlete breaking the law is problematic -- at least to some people," he (Fainaru-Wada) said.

"Some" is the operative word in that statement, according to Penn State professor Dr. Charles Yesalis, an expert on performance-enhancing drugs.

"I've seen numerous fans say, 'I don't care. I just want to be entertained,' " Dr. Yesalis said. "I've talked to a lot of young people. They aren't bent out of shape about this.

"I think in the under-40 crowd, it's strictly entertainment, and if they use drugs to make it more entertaining, whatever."

(more after the jump)

 

Review from Stanford says HGH no benefit as PED

In a comprehensive review of HGH used as a PED (performance enhancing drug) a team at Stanford says that current evidence suggests no anabolic effect for the hormone.  (although this paper is called a study, it isn't; it is a review or meta-analysis of past papers)

Athletes who take human growth hormone may not be getting the boost they expected. While growth hormone adds some muscle, it doesn't appear to improve strength or exercise capacity, according to a review of studies that tested the hormone in mostly athletic young men.

"It doesn't look like it helps and there's a hint of evidence it may worsen athletic performance," said Dr. Hau Liu, of Santa Clara Valley Medical Center in San Jose, Calif., who was lead author of the review.

Growth hormone, or HGH, is among the performance enhancers baseball stars Roger Clemens and Andy Pettitte were accused of taking in the blockbuster Mitchell Report. Clemens denies using the hormone, while Pettitte admits using it.

Will there be new studies of HGH as a PED?  Maybe, maybe not.

But the new research has some limitations and sheds no light on long-term use of HGH. The scientists note their analysis included few studies that measured performance. The tests also probably don't reflect the dose and frequency practiced by athletes illegally using the hormone. Experiments like that aren't likely to be conducted.

"It's dangerous, unethical and it's never going to be done," said Dr. Gary I. Wadler, a member of the World Anti-Doping Agency and a spokesman for the American College of Sports Medicine.

There were significant differences noted with HGH, in the analysis.  Lean body mass increased in the HGH subjects.  Strength (measured in the studies) did not increase in the HGH subjects.  However side effects became more prominent with HGH use -- edema (tissue swelling) and and joint aches (like carpel tunnel syndrome).

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.

 

The USOC (US Olympics), MLB (baseball), and the NFL partner against doping and steroids

The three most powerful sports organizations in the country - The Olympics, MLB, and the NFL, will partner to fight doping and steroids.  An announcement today initiated the Partnership for Clean Competition (PCC).

The Partnership for Clean Competition (PCC) will, for the first time ever, combine the resources and expertise of many of America’s leading sports entities to underwrite meaningful and scientifically-legitimate anti-doping research. Beginning this year, the focus of the PCC will be to fundraise and make targeted grants in support of non-partisan and independent scientific research to be conducted at universities and other world-class research institutions. Priorities for the collaborative will include underwriting research that addresses:

• new methods to more cost-effectively detect and deter the use of banned and illegal substances at every level of sport
• identification and detection of designer substances
• the consequences of doping, from both a medical and ethical perspective
• the further development of a widely-available, cost-effective test to detect Human Growth Hormone (HGH)

The PCC will sponsor research into anti-doping measures.  Note the NBA, the NHL, PGA and other sports organizations will also participate in this collaborative effort.  First order of business: find a test for HGH.

As the initial Founding Partners, the USOC, USADA, MLB and NFL have collectively committed to contribute $10 million to this landmark collaborative. Each Founding Partner will have one representative on the Board of Governors, which will oversee the research collaborative.

Also participating and contributing financially to the research collaborative are the National Basketball Association (NBA), National Hockey League (NHL) and Professional Golfers’ Association of America (PGA). The Founding Partners will seek to raise additional funds and include other entities (both sport and non-sport) in the collaborative as well.

Will the NFL and MLB really support this coalition?  If a player is a steroid user, will he be banned from the Baseball Hall of Fame, and stripped of records, as a Olympic track athlete may be stripped of medals and records?

Mind doping: The next generation of enhancement

Several news article focus on 'mind doping' or maybe we should call them "Cognition Enhancing Drugs (CEDs)'.

Nature calls the drugs 'Professor's Little Helper'.  Stories also in The London Times, and the Atlantic.  Nature states:

Today there are several drugs on the market that improve memory, concentration, planning and reduce impulsive behaviour and risky decision-making, and many more are being developed. Doctors already prescribe these drugs to treat cognitive disabilities and improve quality of life for patients with neuropsychiatric disorders and brain injury. The prescription use of such drugs is being extended to other conditions, including shift-workers. Meanwhile, off-label and non-prescription use by the general public is becoming increasingly commonplace.

Although the appeal of pharmaceutical cognitive enhancers — to help one study longer, work more effectively or better manage everyday stresses — is understandable, potential users, both healthy and diseased, must consider the pros and cons of their choices. To enable this, scientists, doctors and policy-makers should provide easy access to information about the advantages and dangers of using cognitive-enhancing drugs and set out clear guidelines for their future use. To trigger broader discussion of these issues we offer the following questions, to which readers can respond in an online forum. Now, on to the questions.

Mind Hacks describes things this way:

These are the same drugs that have caused concern about their level of use among students, chiefly modafinil (Provigil) and methylphenidate (Ritalin), although other drugs such as Alzheimer's medication donepezil (Aricept), non-amphetamine ADHD drug atomoxetine (Strattera) are also candidates.

The issues are delineated:

Many of the ethical concerns centre around a potential future where brain enhancing interventions are largely available to the wealthy, leading to a 'brain gap' where the less well off will have relatively poorer mental functioning because they can't access the same cognitive benefits.

Not to mention cheating.  As with HGH, only the relatively wealthy can benefit from this sophisticated cheating.

So there is something to 'think' about this year at holiday time.

Here's wishing everyone very happy and much enhanced holidays.

Still obsessed with pink in the Hawkeye State

A few years ago an adjunct professor of law got in a snit about the legendary pink locker rooms at Kinnick Stadium in Iowa City, installed by Hayden Fry.   She is still seeing red over pink.  (The Wizard of Odds is Pretty in Pink too)

Seems when Iowa remodel Kinnick stadium, the AD kept the pink: pink alls, pink showers, pink potties.  How dainty.  Perhaps this decreases testosterone levels. (From the Daily Iowan)

A former University of Iowa law professor wasn't too happy two years ago about the pink-clad visiting locker rooms in Kinnick Stadium. At the time, she grumbled mightily.

The athletic department followed up those protestations with an $86.8 million renovation that included a new and improved locker room: Instead of just pink walls, the facility now has pink metal lockers, carpeting, sinks, showers, and urinals. Sorry, not pink, "dusty rose."

Further incensed, the law professor is starting up her campaign once again, the Daily Iowan reports, and is planning to file a Title IX complaint against the school. "I want the locker room gone."

Pink sometimes works it if is the right shade, and sometimes pink makes Floyd more angry.  Color Matters has this to say:

Can pink make strong men weak? Do pink jail cells create a calming effect? Is it true that football locker rooms (the ones for the visiting/opposing teams) are painted a certain shade of pink to weaken the players?

Yes and no! Here are the facts and some opinions...

...Prisoners did respond and calmed down, as hoped, initially. Major goof: If they hung around too long, they became even more violent. Why? The reasons are so very very clear

So the pink may have a paradoxical effect.  Perhaps that is why with a bowl bid on the line Iowa (6-6) lost at home to a 3-7 MAC team, Western Michigan.  Pink was not the link that time.

Color Matters also reports:

In summary: The status of pink football locker rooms today

University of Hawaii associate head coach George Lumkin was a member of the 1991 staff that saw visitor locker rooms at Iowa and Colorado State painted pink in the belief that the color made players passive. Now the WAC has a rule that a visiting team's locker room can not be painted a different color than the home team's. In other words, it can be pink, black or any color of the rainbow, as long as both locker rooms are the same color.

So pink is punk...

The 'Roid Report debuts on Epic Carnival

The huge news today included a devastating day on the college football gridiron as #1 Mizzou and #2 West Virginia lose, a nasty ice storm pounds the Midwest, and our weekly report on PEDs debut at Epic Carnival -- The 'Roid Report.

As we noted in a post last week, sports stories consist of 4 items now:

• Action on the field
• Contracts, free agents, and trades
• Legal troubles
• Steroids and PEDs

We should add these issues:

• Injuries
• and the BCS

The 'Roid Report will document the week in PEDs.  Performance Enhancing Drugs appear here to stay, and here to cause scandal after scandal.  We feel that the failure of society and leadership to come to grips with the ethics of scientific advances, and the limits of medical technology has led to the problems with PED use.

Rather than discuss how the managers in the front office of the teams, the athletes who play the games, the fans who watch the games, and the medical professionals who treat the athletes all think about performance enhancement, 'we' treat the issue like an exercise in forensics: bad boys and bad girls cheat.

There is an element of cheating in current PED use as the code of ethics is currently constructed.  However, the use of PEDs should be discussed in terms of results, side effects, long term consequences, ethics, and economic feasibility.   We hope we can advance this discussion.

Whithered testicles: Brits say boys as young as 11 use 'roids to impress the ladies

In a shocking expected (of course kids emulate their idols) new study, The British Council on the Misuse of Drugs announced that boys as young as 11 use steroids to get that slugger's physique, to impress the girls and win friends.  Worse yet, some emulate boy band members. From the Daily Mail:

The Advisory Council on the Misuse of Drugs said there was increasing evidence of youngsters injecting the bodybuilding drug, which can lead to rapid muscle growth. It came as they confirmed they are reviewing the legal status of ecstasy as well as cannabis.

A survey found one in every 200 11-to-16 year olds had tried steroids.

Committee member Lord Adebowale: "These are being used not just by athletes but by people who want to be in boy bands and get girls."

 

The British Govt expresses extreme consternation about the most serious of all steroid effects:  acne, breasts, and whithered testicles"

The advisory council will write to Home Secretary Jacqui Smith to warn about the trend, which can lead to long-term health problems for children – including sterility, acne, liver tumours and the growth of breasts in boys.

"It can also make the testicles wither – which is probably not what the users want," said Professor Sir Michael Rawlins, the chairman of the committee.

"Even more worrying, there is emerging evidence that anabolic steroids cause aggression.

"I am really very worried about that. I shall write to the Home Secretary explaining our very grave concerns about this."

If the current state of bullocks weren't bad enough, think of all the potential shrinkage in the years leading to the 2012 Olympics in London:

 

They also fear a boom in use of the drug by athletes in the run-up to the 2012 Olympics. The figures revealed that 200,000 people in Britain have tried anabolic steroids, with 42,000 saying they had used them in the last year.

 

London Bridge ain't the only thing  falling down across the pond.