A Quick Thought on Melky Cabrera

Yesterday, the news came out on Melky Cabrera testing positive for testosterone and that he would be immediately serving a 50 game suspension.  As I understand the suspension, it means that he will be available for the playoffs if the Giants make it.  Several writers reacted to the news:

John Sickels
Cabrera has greatly exceeded expectations the last two seasons, and now we know why. Certainly, his record as a prospect didn't imply that he was capable of this kind of performance.

Danny Knobler
Yes, Melky suspension is tough on Giants. But as one player from another team said, they already benefited from his cheating.

Jon Heyman
His career turnaround seemed too good to be true. And so it was.

All of these are really unsubstantiated comments.  Danny Knobler implicitly agrees with an unnamed player making a conclusion based on unsubstantiated connections between drug use and performance.  Jon Heyman falls into the same boat.  John Sickels, a conduit for evaluation on prospects, should know full well that player development is not linear.  It surprises me that someone who has spent his life analyzing player performance would so quickly attach himself to the idea that testosterone cures all.  It is disappointing to read such a knee jerk response from a writer who was really the person who got me into more critically evaluating prospects.

What do we know about testosterone and athletic performance?

Testosterone will increase muscle mass.  It will increase muscle mass more with exercise.  This muscle is largely functional in that it certainly does increase strength (something human growth hormone has not been found to do making it the biggest bogeyman of this thrashing, poorly thought out effort to reduce PED use in baseball).  So, yes, testosterone will make you bigger and stronger and using it with a great deal of hard work will make you even bigger and stronger.

This leads to the next part of the logic train: does strength mean you are a better baseball player?

Maybe, but we do not know.  I think everyone is aware of the wall of sound declaring that PEDs actually increase performance, but there actually is a great body of evidence suggesting otherwise.  The answer is not incredibly clear cut, so to immediately assume everything is a mirage is somewhat Chicken Little-ing the discussion.

That is what truly irritates me about the whole PED discussion...it simply is not a discussion.  It is a horde of folks running and chasing after an easy concept without truly considering the complexity of the situation.  Human growth hormone supplements could have been an amazing conversation about the state of science and how athletes are using the substances.  Instead, we throw every player using into a raging fire where taking a more conservative approach would have enabled us to determine more clearly whether or not a substance improved performance or not.  This resulted in MLB spending millions of dollar to initiate and maintain an HGH program that likely roots out (poorly) usage of a substance that in all likelihood does nothing to improve performance.

Honestly, I think the only proven effects of PED use in baseball is lazy sports writing.

Yes, Melky cheated.  No, we don't know if him cheating with testosterone had anything to do with his improved performance.  It probably is not directly unrelated.  It probably has a great deal of placebo effect riding on it.  However, a lot, if not almost all, of it is likely Melky.  His career walk rate, strikeout rate, stolen base rate, and home run rate are all in expected ranges.  The difference is that he BABIP is about 20% higher than his career level (and we should expect that to crash) and, with that increase in BABIP, he is showing an increase in secondary power.  For a player at an age where peak performance could be expected and someone who had not to dissimilar seasons in 2011 and 2009 when accounting for BABIP...this season is really not remarkable.

Why do baseball players use hGH: Part II, The Science

An unlikely way hGH improves performance.

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Last time, I wrote about how and why players use PEDs.  Included in that post was highlighting how sometimes players are ahead of the science (arguably steroids) and at other times behind the science (i.e. urinating on your hands, rubbing your bats with ham bones, and arguably steroids).  Somewhat blind assumptions, halo effects, and mob mentality tend to shape an uninformed perspective more so than what experts say is likely or know to be true.  I forget where I saw this and cannot seem to find it, but a study that surprised me was a study that consisted of telling participants various surprising facts.  These facts were differentiated in that some were attributed to "experts" and others were just given.  Participants were more likely to accept surprising facts from non-expert sources.  So . . . maybe there is a fourth effect, which is perhaps a societal suspicion of scientific literature, which I think would be largely due to a misunderstanding of the scientific method.  People often want definitive answers and there are awfully few laws in science.  Anyway, this is going on a tangent.

However, with all that being said . . . that players are using something to give them a competitive edge is a great reason to investigate on the efficacy of the treatment.  Sometimes lacking a full comprehension of something does not prevent someone from discovering something new.  What many baseball players have become are alchemists.  Alchemy had its usefulness as it encouraged the works of many, such as Isaac Newton and Paracelsus.  It also fostered some silly beliefs such as all things could be turned into gold.  So, it may be that baseball players and others have actually hit gold on hGH.

In today's article, I'll be reviewing (or, more aptly, summarizing) several articles about hGH and its effect on athletic performance.

Where did the hGH craze begin?
In 1990, an article was released by Rudman et al (New England Journal of Medicine) in which twelve elderly men ranging in age between 61 and 81 years old were injected with hGH at a concentration similar to what would be found in young adult males for six months.  The twelve subjects were found to have about a ten pound increase in lean muscle, a seven pound decrease in fat, and denser bones.  The conclusion stated that these effects were like a ten to twenty year reversal of aging.  An eager medical and pharmacological community aware of the future elderly care scenarios with baby boomers embraced the possibilities suggested by this article.  It also resulted in a boom of pseudoscience and pseudomedical claims and clinics advertising assumed benefits of hGH.  Claims have included that hGH improves eyesight, removes scars, renews interest in sex, resurgence of hair growth, increase in muscle strength, increase in stamina, and deepening of one's voice.  These benefits extended well beyond the boundaries of the scientific data, claiming that hGH could inhibit processes that lead to aging.  However, these claims tend to ignore several follow up studies that dispute their proclamations.

A good summary of follow up studies was provided by Mary Lee Vance in the New England Journal of Medicine in 2003:

A recent double-blind, placebo-controlled study involving 27 women and 34 men, 68 to 88 years of age, who were given growth hormone or placebo for 6.5 months confirmed the effects of growth hormone on body composition; there was no change in muscle strength or maximal oxygen uptake during exercise in either group.3 This study corroborated the findings of a study by Papadakis et al. involving 52 healthy men, 70 to 85 years of age, who were given placebo or growth hormone for six months. Not mentioned on the “antiaging” Web sites is a study of 18 healthy men, 65 to 82 years of age, who underwent progressive strength training for 14 weeks, followed by an additional 10 weeks of strength training plus either growth hormone or placebo. In that study, resistance exercise training increased muscle strength significantly; the addition of growth hormone did not result in any further improvement. Going to the gym is beneficial and certainly cheaper than growth hormone.

 Ok, so it is fairly well shown that hGH does not seem to help the elderly increase functional strength, but we can probably agree that an elderly population may not be equal to a younger one.  After the jump, we'll review the literature highlighting studies on hGH use in athletes and young adults.  This short review will consist of an example of one of the many studies showing no difference, the only study showing a difference, a couple review papers, and expert testimony from the congressional hearing a couple years ago.  I could have written a far longer piece going over a couple dozen studies, but figured that excess would not convince anyone one way or the other more than the review papers do.  I also figure the review papers provide a stronger summary than I can at this moment.

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.

hGH Test Claimed Successful; Rugby Player Banned

A rugby player was found to have hGH in his system and will now serve a two year ban from the sport. Here is a quote from the article:

Both the United Kingdom Anti-Doping agency (UKAD) and the United States Anti-Doping Agency (USADA) trumpeted the positive HGH test of British professional rugby player Terry Newton as "proof positive" that the drug can be detected in blood tests. Newton, who was tested in November, did not contest the result and yesterday was banned from the sport for two years by UKAD. Newton's rugby club, Wakefield Trinity Wildcats, also canceled his contract. Newton is believed to be the first case of a professional athlete testing positive for HGH using a blood sample.

Read more: http://www.nydailynews.com/sports/baseball/2010/02/23/2010-02-23_hgh_positive_in_rugby_puts_mlb_on_deck.html#ixzz0gO14EjBK

What does this mean for baseball players?

They should immediately demand that they be tested for it. After all, there is no evidence, despite years and millions spent, that any hGH treatment (alone or in conjunction) improves athletic performance.

Performance Enhancing Drugs and Sports Illustrated

Over at CosellOut, they have done a great job of linking to all of the stories about PEDs in Sports Illustrated starting 1969. Bill Gilbert wrote a three part series on drug use in the summer of '69. The second part focuses on baseball and is a must read. The first hGH article is printed in 1984. This should not be considered a full history.