Transcript Benzedrine inhaler, 1928

Performance Enhancing Drugs in
Sports
• Joseph Kenny, MD
• Saturday, Dec 3, 2011
A little about the history, use, abuse,
side effects and folklore of -•
•
•
•
Anabolic steroids
Stimulants
Human Growth Hormone
Erythropoietin
Full disclosure
• I have no financial conflicts to report
• All images used are either in the public
domain, images that I created, or subject to
the fair use exception
• All opinions expressed are my own
This presentation will have about
as much FOLKLORE as it does
SCIENCE
Objectives
• Learn a little about the history of the four
major classes of performance enhancing drugs
• Know the main physiologic effects of these
drugs
• Understand the adverse effects of these drugs
• Review common and not-so-common excuses
for failing a drug test in light of the physiology
of the drugs
• "Because they are banned substances in
sports, and because they are dangerous
substances that can cause irreversible harm,
it's not ethical to do true scientific studies of
these medications as they actually are being
used. So we are kind of stuck on the
anecdotal experiences as far as what's going
on with illicit use.“
• Marc Safran, Sportsmedicine, UCSF
Anabolic Steroids
•
•
•
•
The Brown Sequard elixir 1889
May 1935, Testosterone is isolated
Dianabol 1958
The cream and the clear, 1999
Main effects of anabolic steroids
• Increase protein synthesis – build muscle
• All have virilizing effects to some degree
• Most popularly used steroids have a relatively
high anabolic:androgenic ratio
• There is clearly a psychological effect as well –
increased aggression, appetite for competition
and hard training
1889 – the Brown-Sequard Elixir
Pud Galvin
Dianobol 1958
Victor Conte
•
•
•
•
Bay Area Laboratory Cooperative (Balco)
Formerly bass player for the Tower of Power
Developed “the cream” and “the clear”
Pioneered “informational” drug testing
The cream and the clear
• The cream – A transdermal steroid
preparation of testosterone and
epitestosterone designed to evade detection
• The clear (tetrahydrogestrinone) was a new
steroid designed by chemist/bodybuilder
Patrick Arnold, also designed explicitly to
evade detection
Anabolic Steroids side effects
• Men: Testicular shrinkage, oligospermia,
impotence (HCG)
• Gynecomastia: tamoxifen
• Women: Facial hair, deepening of voice,
shrinkage of breasts, menses disrupted
• Both: Acne, hypertension, elevated
cholesterol, hypercoagulabillity
Chris Benoit
• Professional wrestler who killed his wife and
son, 2007, then hung himself. He was using
alprazolam, hydrocodone, and testosterone at
the time.
Steroids for Cosmesis
Arnold Schwarzenegger
Debbie Clemens
Sylvester Stallone
Hulk Hogan
What do these three have in common?
Benzedrine inhaler, 1928
Main effects of amphetamine
•
•
•
•
•
Lessened fatigue
Perception of more energy
Better ability to concentrate
Improved reaction time
Euphoria
Here I sit
All alone with a broken heart
Well, I took three bennies
Now my semi truck won’t start
Need to be in Cincinnati Monday
morning to draw my pay!
Take three more bennies
Then PULL truck to Cincinnati
Side effects of amphetamine
•
•
•
•
Aggression
Anxiety
Tachycardia, arrhythmia
Hallucinations, psychosis
Can you identify this individual?
He was an emergency room doctor
•
•
•
•
Practiced in Fort Bragg, North Carolina, 1970
Graduate of Northwestern Medical School
Married, father of two daughters
Daily user of amphetamine, which was
available in “candy bowls” to be taken ad lib
by emergency room personnel
Human Growth Hormone
• Originally harvested from cadaver pituitary
glands
• Recombinant HGH 1981
• Creutzfeldt-Jacob Disease in cadaver-derived
GH recipients in 1985; product removed from
the market
• There are now at least six different
manufacturers of recombinant HGH
Growth Hormone and Athletic
Performance
• There is a stunning paucity of evidence that
Growth Hormone helps athletic performance
• Nonetheless, anecdotal data suggest use is
fairly widespread
• Goal is reduced fat and increased muscle
• Testing is difficult; to date, very few positives
in testing
Side effects of HGH
•
•
•
•
•
•
Arthritis
Diabetes
Big Jaw
Big Hands and Feet
Cardiomyopathy
Atherosclerosis
Andre Roussimoff
Blood Doping
• Can be done via homologous or autologous
transfusion
• More commonly done via erythropoietin,
darbopoietin, or CERA (PEGylated epo)
• High performance endurance athletes can
likely tolerate very high hematocrit,
nonetheless occasional death due to
hyperviscosity
Tour of California
The Vengeful Massage Therapist
Justin Gatlin
Photosynthesis
• My carbon signature is plant - like
Floyd Landis
It was my oral contraceptive
• That’s why my testosterone to
epitestosterone ratio is 400:1
Mary Decker
I am a chimera
It was my evil twin
Tyler Hamilton
My drink was spiked
• By one of my jealous rivals
Ben Johnson
My toothpaste was adulterated
• By a late night intruder
Dieter Baumann
It must have been contaminated beef
• That’s why I have nandrolone in my
system
Petr Korda
I have narcolepsy
• That’s why I am on modafinil (and
tetrahydrogestrinone and erythropoietin)
Kelli White
It was that male enhancement pill
• I am so embarrassed
LaShawn Merritt
I have a tumor
• That’s why I tested positive for human
chorionic gonadotropin
Brian Cushing