IGF-1 gets no respect

Monday, January 13, 2014

In describing Alex Rodriguez and the use of performance enhancing drugs, presumptive may be appropriately used, since as has been thoroughly noted by him and his spokespersons, he has never failed a drug test. Lance Armstrong also did not fail drug tests for PEDs but presumptive was removed from his status when he confessed to their use.

For Mr. Rodriguez, the battle continues but the specific types of drugs allegedly used are now public, after the Biogenesis files were made available in lawsuit documents. The culprits were testosterone, insulin growth factor 1 (IGF-1) and human growth hormone (HGH), the triumvirate of drugs that can be legally prescribed by a physician to treat a range of medical conditions. They may also be legally prescribed off-label to be used as the patient and physician see fit. The issue for Mr. Rodriguez is that these medications were neither prescribed by a physician nor allowed by his employer. While it is not illegal to have the substances in his body (though not proved by testing), Major League Baseball and its players union have agreed that performance enhancing drugs do not belong on the field of play.

The world has heard about HGH and testosterone, but IGF-1 is a silent partner in performance enhancement. The pituitary gland in the brain produces HGH and released into the blood stream, where it activates the liver to produce IGF-1. It is chemically similar to insulin but has a specific cell receptor that helps promote growth in almost all cells in the body, including muscle and cartilage. People need adequate levels of both HGH and IGF-1 to grow properly; lacking either chemical may be the cause of syndromes associated with short stature. IGF-1 levels in the body peak just after puberty allowing for the teenage growth spurt and fall off with age. HGH is useless unless the liver can produce the active ingredient IGF-1.

IGF-1 is responsible for cell growth and its presence decreases cell aging and death, which is a wonderful thing for growing healthy young people but may cause problems with cells that should die but do not. IGF-1 increases the growth of cancer cells and those who are deficient have a lower rate of cancer.

Pharmaceutical companies had high hopes for IGF-1 to help treat diabetes (it is closely related chemically to insulin), short stature like dwarfism and because of its cell growth properties, burns, Alzheimer’s disease and Lou Gehrig’s disease (ALS). Unfortunately, research results are mixed and potential side effects are real. There is no indication to treat New York Yankee third basemen.

The law allows Mr. Rodriguez to use performance enhancing medications as prescribed by a physician. Sports organizations worldwide ban their use to help maintain a level playing field and prevent one athlete from obtaining an unfair advantage over another and to prevent potentially lethal side effects. The ban of PEDs also prevents the creep of their use in younger athletes. If PEDs are required to succeed in the pros, then college athletes will use them; high school athletes will then begin abusing the drugs in their hope of getting college scholarships; middle school kids will use drugs to make high school varsity.

Lance Armstrong proved that his chemist was better than those employed by organized sport and he was able to beat the testing process. Alex Rodriguez remains an alleged used of PEDs because he too, has yet to test positive. Perhaps the time has come for pro sports to start drafting PhDs in chemistry.

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the ethics of doping

Monday, February 4, 2013

The latest edition of the Super Bowl had more than its share of compelling story lines, brother versus brother, an aging veteran playing his final game and a new quarterback whose star was rising. But underneath all of that positive good feeling was the menace of a couple drug abuse scandals raising their dark heads.  A shady Florida anti-aging clinic run by a doctor and his son was implicated in providing anabolic steroids to some of the best baseball players in the world. And in a perhaps stranger case, Ray Lewis presumably used deer antler spray, holographic stickers and special water to recuperate from a significant arm injury.

Ray Lewis first.  Deer antler velvet is a long sought after oriental remedy that presumably increases performance. One chemical that it does contain in very minute quantities is IGF-1, insulin- like growth factor, a banned substance in athletic competitions, including the NFL.

This is how it works. The hypothalamus, a gland in the brain, produces Growth Hormone Releasing Factor that signals the pituitary, another gland in the brain to release Growth Hormone. This signals the liver to release IGF-1 into the blood stream to stimulate the growth and proliferation of many cells in the body including muscle, bone cartilage and nerves. While IGF-1 has a major benefit in increasing performance, its downside is that the hormone inhibits or decreases programmed cell death. Many of the body’s cells have a defined life span and billions of cells die each day. Interfering with the life cycle of a cell can potentially lead to significant diseases like cancer. Old cells may contained old, damaged DNA that gets passed to new generation cells.

The general public tends to consider the use of performance enhancing drugs cheating however using IGF-1 spray raises an interesting ethical issue. Deer antler spray has insignificant amounts of this chemical, but, more importantly, the spray is deactivated by digestive enzymes in the mouth and stomach, does not enter the bloodstream and causes no biologic effect within the body. IGF-1 is chemically related to insulin and for this same reason, insulin cannot be taken by mouth nad must be injected into the body. Any positive benefit received from the use of oral IGF-1would be due to a placebo effect, and likely also the benefit found in the use of stickers and special water. Thus the ethical dilemma. Mr. Lewis’ intent was to use a performance enhancing drug but the one chosen was improbable and ineffective. The intent to commit a crime did not result in one being committed but there was benefit in the actions.

As for the athletes who received performance enhancing drugs including testosterone and growth hormone from the Biogenesis clinic run by Dr. Pedro Bosch and his son Anthony, no ethical question exists. The investigation by the Miami New Times is a worthwhile read. While it is not illegal for the doctor to prescribe and inject hormones into his patients, their use in the athletic arena is not allowed. Each sport has its own list of banned substances, but performance enhancing drugs like anabolic steroids are never allowed.

There are four tiers of athletes. The first includes those who are genetically gifted and work hard to excel and maximize those gifts. The second are those not so endowed but whose dedication to their sport allows them to perform at an elite level. Tier three is reserved for those who are gifted but who do not invest the time and effort to succeed and finally the lower tier is reserved for those with little talent and less effort. The use of performance enhancing drugs is a shortcut used to elevate their game to the next level. If it means becoming a superstar or just making the team, the use of PEDs unlevels the playing field and makes the competition unfair.

The public expects that athletes succeed because of hard work, motivation and dedication. We cheer the success of those on the podium but sadly, a tinge of cynicism can limit our ability to celebrate. If one athlete dopes, we presume that others are implicated by association. If Ray Lewis used deer antler extract, (a 21st century snake oil), then he did not cheat in the technical sense of the word. He did not benefit from IGF-1, but only because he failed the science.

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