17 February 2011

Why baseball players use human growth hormone? Part I: Addressing the debate.

Cheating comes in a lot of forms.
This is the first part of a two part series on human growth hormone.

Performance enhancing drugs (PEDs) are a difficult topic to discuss.  It is truly rare to find someone who is indifferent to them or at least not emotionally engaged in the discussion.  I find that we, fans, want to see amazing athletic performances, but want these to be as clean and pure as is possible.  We often create dividing lines between things like spitballs, corked bats, corrective lenses, cortisone shots, oxygen treatments, creatine, anabolic steroids, Viagra, caffeine, Ritalin, human growth hormone, and a bevy of other treatments that have been associated with improving performance.  Everyone typically has their own line and many fight for it vehemently.  The line drawn often rarely is with respect to how much certain aids helping in making a performance better and more often drawn by our emotional attachment to different approaches.

Emotional arguments are difficult ones to have as it is difficult to consider evidence that contradicts our position.  Turning a logical argument into an emotional one shifts the debate from one of merits of an idea to the mere capacity of intellectual thought.  This creates a conversational quagmire when trying to parse the data on a subject that is confusing and often misconstrued in the media, in the gym, and on message boards.  What I hope in this two part series is to set the emotional conversation back to zero and build it back up on the merits of the application of human growth hormone, in this case.  That way maybe we can strip the discussion free of our assumptions and weakly based convictions

More right after the jump.

For the purpose of disclosure, I should more formally introduce myself.  I find the typical "About Us" pages to be rather boring, but find that it may make sense to do so here.  I played baseball until my freshman year in college where my arm was so incredibly shredded, it became impossible for me to play even first base.  I then shifted my interest over to analyzing baseball.  As a biology and chemistry major, I had a great deal of interest in PEDs in baseball.  At that age though, education makes one drunk on how essential and powerful knowledge is.  The undergraduate courses I took and the biochemistry I understood was simplified and we never strayed too far from the basic concepts provided by our text books.  It made me think the world, particularly aspects of the human body, were easily understandable and mastered.  Steroids and everything else seemed like such a simple one to one relationship of great performance and usage. It made narrative sense.

Since then, I have acquired a masters and a doctorate in toxicology.  I have spent time consulting and am now involved in regulatory work.  I have learned just how much we do not know and how tenuous my trust was in group think about a wide range of topics.  This included the status of some alleged PEDs.  I had thought just because players were tended to by glorified pharmacologists and gym rats, that they somehow were on the cutting edge of drug therapy.  That there was this amazing, validated, underground collection of information ready for any baseball player to take the plunge into some murky ethics in order to become more successful or merely to meet the emerging status quo.  That is an enormous assumption.  I mean, baseball players are notorious for individual and group superstitions.  They can be as troubling and silly as Jason Giambi's slump busting shared gold thong.  They can be as nonsensical as religiously rubbing a bats with a soup bones.  They may also be, with hindsight, monumentally strange as when teams would wear swastikas for good luck.  I would imagine none of you would think any of these would help a team win a game beyond a placebo effect.

Only Known Steroid User in the HoF, Pud Galvin
Group think nowadays, from our own perspective, is often substantiated by pseudo-science.  Off label usage of drugs is incredibly important.  It enables researchers to wedge open new lines of therapy that shear cost may prevent in order to establish a consideration for a revised label.  For anyone who has Lupus or cancer or many other diseases, off label clinical results often result in false hope seeded by studies without amble sample size or measuring the right biometrics.  One of the more interesting clinics occurred in 1889.  Pud Galvin, a pitcher at the end of his career, joined a treatment clinic to test an injection that was supposed to result in greater vitality. In 1889, the Washington Post reported:
If there still be doubting Thomases who concede no virtue of the elixir, they are respectfully referred to Galvin's record in yesterday's Boston-Pittsburgh game. It is the best proof yet furnished of the value of the discovery.
The elixir in question was Brown-Sequard elixir, which was an injectable liquid made from guinea pig and dog testicles (it may have been made from monkey testicles as well).  The results of the study appear lost and, I imagine, no one bothered to really put it through any strict assessment.  Studies at this point rarely were tested with statistics.  Conclusions were generally drawn from anecdote and logic.  For baseball though, it took nearly a hundred more years for the Bash Brothers of Oakland to cement the concept of greater baseball through chemistry.  There was always dabbling in drugs here or there.  Amphetamines supposedly became the big thing as military men came back from World War 2.  It really was not until the steroid binge of the 90s that it really became embedded in baseball culture.  The embracing of weight training went largely against the conventional wisdom of the previous decades about the effects of reduced flexibility.

As easily as it is for us to look at steroids as proof of evidence that human growth hormone must work, we casually ignore that for decades baseball players en masse thought testosterone and steroids were of no help with some thinking it to be a hinderance.  This is not a group that is deep in waiting for results.  Experimentation in the club house often precedes experimentation in the laboratory.  Experimentation in the laboratory rarely ever permits dosage as high as people dare in the clubhouse.  Likewise, the clubhouse is not a stickler for the scientific method.  A proof of concept is supported by the halo of success.  If a good player uses something and he succeeds, by connection, the drug is what helps him succeed even though that may not be true.  It is merely perception.  Sometimes perception is true, sometimes it is not.

An interesting example of performance as proof  has to do with Jorge Posada.  Posada and a handful of others were known for urinating on their hands to prevent cracking and opening of skin.  Now, he did not invent this.  He was not the first to do this.  He is merely one in a long line of players who took this approach.  He surely is not the last (so remember your Purell if you plan on shaking players' hands).  What is amusing to me is that this almost would work.  Synthetic urine or similar chemicals are often found in hand moisturizers.  Those chemicals require carrier agents though to make it into the skin.  Without them, the synthetic urine would almost entirely drip right off the skin.  Likewise, urinating on your hands will not permit enough contact time to allow the urea to permeate the skin.  Instead, you would need to soak your hands in a bucket of urine for about 10 minutes for the same effect.  I imagine the idea originated as a product of the beauty industry.  Sterilized animal urea was often used in beauty products until they were replaced by synthetic urea and later chemicals with similar properties.  A misunderstanding of product chemistry may have made a player a long time ago think that urine would do the same thing as urine in a moisturizer.  It would be a case of a baseball players understanding just enough of a concept to do something that makes sense, but not enough to know whether it truly would work.  They utilize no rigorous assessment mechanism to know whether it works or not.  So, you get a guy like Jorge Posada who urinated on his hands for three decades.

I hope this first post set things up and hopefully is encouraging people to keep an open mind.  It is important to not only look at the evidence, but also recognize the limitations of measuring effects.  The mere fact that players use a compound means next to nothing.  Players mistakenly do a lot of things, as we all know, that do not affect performance.  We also know that laboratory testing may be limited in what it can observe.  We need to keep these concepts fresh in our minds as we review what we actually know about human growth hormone and determine what its likely effects actually are.  What we conclude at the end of the next part is not a concrete assessment.  As information becomes available, our assessment may change.  It is OK to change your opinion on an issue that is difficult to define.

My next post will focus on the data available for assessing the effects of human growth hormone on athletic performance.

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