when legal is not allowed

Monday, June 10, 2013

The story says that Major League Baseball has reached an agreement with the owners of Biogenesis, a now defunct clinic in Florida, who allegedly supplied performance enhancing drugs to numerous players, including stars like Alex Rodriguez and Ryan Braun. Guilt by association has now been established, regardless how the story ends. However, while baseball may not like human growth hormone (marketed by Pfizer as Genotropin), HGH is a legal medication, available to appropriate patients by prescription. The issue for sport and society is how to explain to young athletes and their families, the risk and rewards of using a medication that has very real adverse side effects.

The story needs to start with a doctor having the power to write a prescription for a medication. While the pharmaceutical company lists the indications for which that drug is approved, once it is on the market, a doctor can prescribe it for any patient they see fit, but it is patient (and physician) beware, since studies may not have been done to establish “off label” benefit or risk. There are success stories and off-label can enter the norm. For example, erythromycin, an antibiotic, may work to help diabetic patients whose stomachs don’t empty well and metoclopramide (Reglan) used for nausea and vomiting, when injected intravenously, is now used routinely to treat migraine headaches. There is power in the doctor’s pen or computer keyboard to sign prescriptions, matching diagnosis and treatment, regardless of the science that may or may not exist.

Back to HGH. Human growth hormone is normally produced in the pituitary gland located in the brain. It circulates in the blood stream and stimulates liver cells to produce Insulin Growth Factor 1 (IGF-1), the active ingredient that stimulates growth. Almost all cells have IGF-1 receptors, being especially active on bone, cartilage and muscle, as well as nerve, bone marrow and lung cells, regulating cell growth and development.

In children, without adequate HGH being produced in the brain, IGF-1 levels are not adequate to promote growth and short stature may occur. The cause may be genetic, acquired (for example a head injury or tumor) or idiopathic, where the cause is unknown. In adults, the only indications are decreased HGH levels because of pituitary disease, hypothalamus disease (the gland that stimulates the pituitary), surgery, radiation therapy or trauma. That has not stopped the new anti-aging industry from promoting HGH as the new fountain of youth. In non-mammals, IGF-1 can slow aging but that research has yet to be proven in mammals, let alone humans.

The ability to compete at a high level in sports requires genetic predisposition, talent and a lifetime of work. Fans reward that dedication and athletes reap the rewards of adulation and money. The use of performance enhancing drugs may unlevel the playing field and the trickle-down effect may cause unintended, significant side effects to the users. When college players feel the need to use HGH to compete with the pros, it causes high school players to consider its use to compete for scholarships. The statistics say that up to 10% of high school athletes have tried anabolic steroids.

The problem is in the side effects. In teens that are still growing, complications of HGH use include scoliosis, if there is already a potential, and slipped femoral capital epiphysis, a fracture through the growth plate of the hip. Other issues include unmasking diabetes, hypothyroidism, pancreatitis, raised pressure within the brain and increasing the cancer risk in some patients. In addition, there can be significant skin swelling, muscle and joint pains, including carpal tunnel syndrome. And then there is the increased mortality rate in acutely ill patients who are using HGH.

The use of HGH and other performance enhancing drugs is banned in baseball. Their use is considered cheating presumably because of the risk to the player. Other performance enhancements, like eye surgery to improve vision, are allowed. On the field, some rules are allowed to be broken. It is “allowable” to throw a spitball or otherwise doctor the ball, as long as you are not caught (Gaylord Perry, Hall of Famer) or the fans can be forgiving for using a corked bat (Graig Nettles, Albert Belle).

For many athletes, the lure large sums of money and the fame of pro sports career, outweighs the real risk that comes with the use of performance enhancing drugs. The sad news is that there are very few who will make the big leagues and the many who have not climbed the ladder, will feel the physical consequences of their drug use without tasting success. A sport may deem drug use unacceptable, but pressure to win may override that decision, especially when the use of that drug is legal.

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