Three historical events dominate the winter of 2008 (in no particular order): the presidential race; brutal winter weather; and Senator George Mitchell's report on the use of steroids and performance enhancement drugs in baseball.
Winter will eventually end. A candidate will eventually be elected POTUS. However, there seems to be no end in sight to the steroids/PEDs controversy in sports. Debaters cannot even agree on what constitutes a PED.
Yankees Andy Pettitte and Roger Clemens, along with several of their compatriots not only find themselves skewered daily in the press, but now endure Congressional probes on their use of 'PEDs'. Pettitte used human growth hormone (HGH) exclusively; Clemens stands accused of injecting anabolic steroids as well as pumping up with HGH.
Paradoxically, the word on the street, the word in the media, the word in the blogs says that no evidence exists that HGH enhances athletic performance. So if HGH fails to enhance performance, why must Congress prosecute the poor Texas Rocket? Why the hubbub surrounding a substance that experts tell us may be about as effective as archaic B-12 shots.
Experiments of nature indicate that HGH does enhance strength and power. The classic 'giant' of history spurts excess pituitary HGH causing excessive growth; pro wrestler Andre the Giant suffered from acromegaly inducing his extraordinary size and strength -- although later in life his muscles wasted away. I once treated a patient who progressed from a normal high school girl to a state shot put champion when her pituitary went berserk producing HGH due to a tumor (a pituitary adenoma).
However, many experts say HGH does not produce champions; others -- including Ben Johnson's former physician -- wink at that statement. What gives?
In the complex physiological milieu that constitutes human biology, hormones like HGH do not act alone. Neurotransmitters, hormones, growth factors, and other biochemicals act in concert with a multiplicity of biological variables to produce behavior, performance, emotions, and the other functions that we call life. Two examples follow:
1.) Methylphenidate (Ritalin) and dextroamphetamine (Adderall) are frequently referred to as 'stimulants'. However, the behavioral effects of these drugs (which can be PEDs) range from improving concentration, to decreasing activity level (hardly 'stimulation') to causing tics, to inducing psychosis. The drug effects depend on many factors: genetic makeup, age, exposure to the drugs, dose, and activity level. There is no universal response to this well-studied class of drugs.
2.) Army veterans know that APC (aspirin, phenacetin, and caffeine) remains a time-tested treatment for pain. However the APC -- or current combinations of aspirin-Tylenol-caffeine drugs -- found a new medical life in migraine headache preparations. I found this out when my wife trumpeted her new treatment for migraine -- an APC; showing my superior intellect and awesome clinical acumen I argued with her that the combo was old-fashioned and ineffective. Of course she was correct. Research shows the APC in combination works as an effective treatment for migraine. Clinical studies also indicate that the combination of APC tests superior to aspirin alone, a Tylenol-like drug alone, and caffeine alone; in fact caffeine alone rates as a very ineffective pain treatment.
Many experts contend that HGH by itself my not increase strength or athletic performance. However, athletes take the drug in combination with anabolic steroids, thyroid hormone, insulin, IGF-1 (insulin-like growth factor), and other 'stacked' PEDs. The effects of these drugs appears to be synergistic.
A UK study showed that HGH increased aerobic performance and respiratory muscle strength in athletes who formerly used anabolic steroids. An Australian study in abstract last spring interpreted results to suggest HGH was not performance enhancing. However when examining the 4 treatment arms, interesting results appeared: neither testosterone nor HGH separated form placebo on measures of oxygen usage, strength (dead-lifting), explosiveness (vertical jump), and a measure of anaerobic work capacity (cycling). However the combination of testosterone and HGH produced enhanced performance on one measure compared with placebo -- a clear synergistic PED effect.
Experts on metabolism and endocrinology suggest that androgenic hormones modulate the response to HGH -- ie. a synergistic effect. The response to HGH becomes even more complicated because another hormone IGF-1 may actually be performing much of the cellular dirty-work for HGH.
Consider that until 1984, testosterone -- now the paragon of a PED -- was not labeled a PED by the American Academy of Sports Medicine. Consider that most PED studies look at 'weekend warriors' and not elite world class athletes. And consider that no scientist has studied the effect of any PED on home run production in a double-blind placebo-controlled cross-over pharmacological study. Considering all these points, saying PEDs affect MLB home-runs -- or any athletic task -- constitutes a classic inductive leap. But a reasonable conclusion in my view.
We could all refer to the 'myth of anabolic steroids', or the 'myth of HGH' or the 'myth of the myth of PEDs'. Or we could conclude that scientific studies of the performance enhancing qualities of these metabolic hormones (testosterone, HGH, IGF-1, insulin, HCG, thyroid hormone) remain incomplete, and will never be totally conclusive. What constitutes a PED depends on a multitude of factors including genetics, dose, synergistic drugs, and work-out effort. However, by using these drugs, an athlete introduces powerful metabolic hormones with myriad effects that alter basic physiological functions. How much enhancement, and how effective the enhancement depends on pharmacological, physiological, environmental, and genetic factors? Odds say that the PEDs enhance measures of athletic performance thus giving an unfair advantage to the PED abuser; the evidence also indicates these hormones produce potentially dangerous side-effects.
These drugs constitute one of the most powerful classes of drugs known to medicine, and not to be entrusted to street dealers, strength coaches, gym rats, juiced outfielders, or mail-order hucksters. Regulation of HGH as a controlled substance seems appropriate. And that's no myth.