Monday, July 29, 2013
“I’m not a role model. I’m paid to wreak havoc on the basketball court.” Charles Barkley
“Charles…I don’t think it’s your decision to make. We don’t choose to be role models, we are chosen. Our only choice is whether to be a good role model or a bad one.” Karl Malone
In 1993, a controversy arose when Mr. Barkley, now a television analyst declared that his job was to play basketball, not necessarily set an example for kids and others in his fan base. His comments came in an era when Nike wanted people to “be like Mike” and buy all things Jordan. Kids tried to copy the moves of their favorite player on the court, in the batter’s box and in the end zone. Twenty years later, the sports hero worship has taken a sad turn and Ryan Braun has become the latest poster child for bad behavior. His tacit admission to abusing performance enhancing drugs and suspension from baseball involves a drug mill in Florida and the revelation that the same clinic was supplying high school kids with HGH and testosterone. Be like Ryan?
Steroid abuse to enhance athletic performance has been a cat and mouse game for decades. Backroom chemists would create a designer steroid that perhaps might not be able to be detected by available drug tests. Athletes would cycle the use of the drugs they put into their bodies, hoping to test clean when their time came to present for urine or blood tests. An industry evolved to mask the presence of an illegal substance and a Google search could find thousands of sites with purported expertise. The advent of “forever young” clinics, promising eternal youth for those who could not come to terms with aging, put anabolic steroids into the mainstream and on Main Street. How could a doctor and clinic prescribe a medication unless it was proven effective, reliable and safe? Welcome to the concept of off-label prescribing.
Human growth hormone (HGH), also known as somatotropin, is produced in the brain’s pituitary gland and is responsible for cell growth and regeneration in the body. It is an anabolic hormone, responsible for increasing height in childhood but is also a major player in muscle development, blood sugar regulation, calcium metabolism, protein production and fat breakdown. For all that it can do in the body, there are very few medical indications for it to be prescribed by a physician.
Pediatrics: Treatment of children with growth failure due to growth hormone deficiency, Prader-Willi syndrome, small for gestational age, Turner syndrome and idiopathic short stature
Adult: treatment of adults with either adult onset of childhood onset of growth hormone deficiency
That’s it. These are the only approved uses of HGH. But once a drug is on the market, a physician can choose to prescribe it off-label. Supposedly, the doctor needs to balance the benefits and risks of using a medication that has not been tested and approved for a specific condition. This is a long honored tradition in medicine and many medications have been recognized for their unintended benefit and have become routine treatments. Erythromycin, an antibiotic, seems to help patients with diabetic gastroparesis, where the stomach doesn’t empty appropriately. Reglan and Compazine, two medications used to control nausea, also seem to abort migraine headaches when injected intravenously.
Off label HGH use to improve athletic performance somehow seems different. HGH allows muscle to recover from injury and overuse, letting players train more aggressively. It can promote lipolysis, breaking down fat stores in the body and may increase lean body mass by increasing the amount of water in muscles cells, but not necessarily increasing the size or number of muscle cells in the body. This is not a wonder drug. There are significant risks that include leukemia, high blood pressure, atherosclerosis, diabetes, thyroid disease and liver and pancreas problems.
Biogenesis, the suspect Florida clinic that was the source of HGH and other hormones to pro athletes, also seemed to have a younger clientele. High school athletes are alleged to have been patients receiving performance enhancing drugs with all the attendant risks that come with taking a drug your body does not need. These were not back alley dealings but instead, parents would escort their kids to Biogenesis in hopes of them becoming the next Ryan Braun.
A year before Charles Barkley demanded that parents and other take the role model responsibility, Lyle Alzado, a Pro Bowl football player and self-admitted anabolic steroid user died of a brain tumor and his portrait on the cover of Sports Illustrated became the face of steroid abuse in the NFL. He repented his drug abuse and urged others not to follow in his steps. We have not learned from history. The golden ring of professional athlete stardom has caused performance enhancing drugs have filtered from the pros to college to high school and slowly into middle school.
Mr. Braun’s reputation will be the most significant consequence of his drug abuse admission but he has a job playing baseball next year and $100 million awaiting him in salary. For every Ryan Braun, there are too man to count players who don’t make the major leagues or even their college team. For them, the consequences may be broken and damaged bodies that will cause them to suffer a lifetime.
Be like Ryan?This entry was tagged Biogenesis, Charles Barkley, HGH, Lyle Alzado, performance enhancing drugs, Ryan Braun
Dr. Wedro weighs in
“The difference between doctors who look after mere mortals and those who look after elite athletes may have to do with how many tests they can order, regardless of the cost.”