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http://www.baseballprospectus.com/article.php?articleid=3659 Steroids in Baseball A Call For Testing In the case of Steroids v. Baseball, a vastly different process than the one that is supposed to be taking place in United States v. Conte, we have all made rash judgments, sweeping generalizations and false conclusions. Steroids, like drugs or Pete Rose, seem to push rationality and logic out the window. Fans and players who love the game passionately defend any attack at the very soul of "our game," so anything that challenges our perceptions, rightly or wrongly, is likely to get this same treatment. Biochem 101 Amidst the hue and cry, what's been missing are some basic facts about the substances in question. For example, there are a number of drugs that have come under the generic word "steroids" that do not include anabolic steroid components. I prefer the term "performance enhancing drug" (PED) as more accurate and encompassing. However, it is even difficult to classify things as PEDs without finding yourself on a slippery slope. Instead, we must further clarify the term. There are legal chemicals and compounds that have clear performance enhancing effects. Coffee, Red Bull or other energy drinks, herbal compounds, protein shakes, and even Gatorade could be considered to enhance performance. Legally prescribed medicines, taken as directed and under a physician's care, may enhance performance. Painkillers and anti-inflammatory medicines, widely used in baseball, definitely allow players to perform more effectively or in situations where, without the chemical intervention, they would be unable to do so. Even medical procedures such as Tommy John surgery or Curt Schilling's ankle repair could be argued to be performance enhancements. We'll coin a new term here: IPED. An IPED is an illegal performance enhancing drug. This new distinction separates out accepted forms like coffee, vitamins and prescribed medicines from anabolic steroids, off-label prescription medicines and controlled substances. It is the IPEDs with which baseball is concerned. There is a grey area between PEDs and IPEDs where drugs such as 4-androstenedione ("andro," made famous by Mark McGwire), ephedra and other compounds reside. It is also a place where misused prescription medicines fall. While legal, it is the intent of the use that calls them into question. Modafinil, a prescription medicine used to treat narcolepsy, helps many suffering from that condition, yet it also has performance enhancing effects for those who do not suffer from an approved condition. No one will question that insulin is one of the great medical discoveries of the modern age, yet athletes seeking advantages on the field can also abuse it. It is then up to the respective governing bodies to determine which substances should be on their banned lists, lists that must be continually updated. It's important to understand that while the term steroid is used generically, steroids are a distinct class of chemicals with certain effects, both intended and unintended. Most steroids are synthetic versions of hormones that, once in the body, have one of four effects: anabolic, androgenic, estrogenic, and progesterenic. Most steroids are anabolic, meaning they have a constructive effect on tissue. I sat down with a pharmacist and chemist to understand these processes; neither wished to be identified for this article because their employers had not cleared their conversation on these topics. "There are four categories," the chemist told me, "but there's overlap. Testosterone, which is the gold standard for bodybuilders or other athletes, has both anabolic and androgenic effects. Once you start complicating the chemistry, there's usually unintended effects beyond simply building muscle." The oft-abused steroid Nandrolone--also called "Deca" and one of the drugs that Jason Giambi admitted using--is nearly testosterone. The chemist explained, "There's a methyl group replaced by a hydrogen at C5." The look on my face revealed that I should have paid more attention in organic chemistry class. "Whether you understand it or not, what you need to know is that in the body, it metabolizes quickly into dihydrotestosterone (DHT). That's a usable by-product and what any steroid user is trying to get to." As steroids get more complex chemically, the effects begin to expand. "Once you get too complex," the chemist continued, "there's a process called aromatization. I won't get into the chemistry, but the basic change is that an androgen converts into an estrogen. That's where the side effects really start." Dianabol and other complex steroids are also subject to another effect--alkylation. "Alkylation makes it difficult for the liver to degrade the compound. It makes them longer-lasting, but also makes them extremely easy to detect. They simply stay in the system longer," the pharmacist added. The effects of steroids--building muscle, easing recovery--are well known. There are a number of diseases for which anabolic and androgenic steroids can make a great difference, such as multiple sclerosis, AIDS and some forms of cancer. The side effects, however, expand as doses extend. "Bodybuilders, and I use that term because that's where we're used to seeing this, use doses that are often literally those a veterinarian would use," the pharmacist told me. "If one is good, two is better. If two is better, ten is great. Unfortunately, as they see the results they want, they also see the results they don't." Side effects include increased moodiness, hair loss (or gain in women), acne, and breast growth in men. Internally, cholesterol (itself a steroid) is affected, reducing HDL counts. HDL is the "good" cholesterol. They can stimulate tumor growth, create liver problems and suppress blood clotting. The effects on sexual glands are great as well. "Pump enough of anything natural into the body and the body adjusts," the pharmacist told me. "If it's there, the body realizes it doesn't need to make its own and stops. It's just that simple. If you keep pumping in steroids and the testosterone levels raise, why should the testicles bother? Eventually, it's 'use it or lose it'--the body doesn't feed what it doesn't need and the testicles can visibly shrink." These side effects can be enough to make some abusers stop, but for others, it leads to "cocktailing" or "cycling." With chemical cocktails or cycles, abusers use timing or other substances to mask or reduce the unwanted side effects of the steroids. "If some football player wants to get bigger, he takes Deca. The deca makes him bigger, but he grows boobs," the pharmacist illustrated. "He doesn't want breasts, so he takes testosterone to mask that. He needs the testosterone to work, so he takes Serophene to amplify the testosterone." Serophene, a prescription form of Clomid, is a drug often used to stimulate fertility in women. "I've read about cases where someone began to lose hair and started on Propecia (a common hair loss treatment). Propecia actually retards a form of testosterone, so he had drugs in his system working against each other!" This internal chemistry set is further complicated by the need by many abusers to not only reduce side effects but to mask their abuse from sanctioning bodies and even coaches or other players. "I've heard every story there is about masking," the chemist said. "There's a whole industry built around beating drug tests. Most of it is snake oil, but there are weaknesses in any testing procedure that can be exploited. Add money to the process and there are going to be both good and bad chemists that are willing to help the process along." Common masking agents are diuretics or other urine-manipulation techniques, while others will simply try to get past tests with slight-of-hand or complex, almost comical devices. Testing is a relatively straightforward procedure. Dr. Lewis Black, the director of Aegis Sciences Corporation, a leading drug-testing lab, was a guest on Baseball Prospectus Radio earlier this year. In that interview, he explained the procedure. "We match a drug chemically after acquiring it from a urine, blood or hair sample. The samples are treated like evidence in a criminal trial, maintaining not only control of the sample, but making sure that it is kept away from any external influence. We match the drugs in something like looking at a police lineup. We have a list of illegal substances and our systems look at the sample. They need an exact chemical match, which is why something like THG was undetectable. It may well have been in the samples, but we didn't know what we were looking for. If it's not known, it's essentially undetectable. Once it's known, it's just a short period of time before we have a test." The test for THG was created only two months after the UCLA-based testing labs used by the U.S. Olympic Committee (and, until a mid-year change, by Major League Baseball) first identified the drug. (MLB now contracts with a Canada-based firm for testing.) The drugs now made famous in the BALCO scandal are known as "the cream" and "the clear", but it's not clear what these substances actually were. The word "steroids" is used too often in the generic sense, while in fact only one of these substances is accurately described as a steroid. "The clear" is THG (tetrahydrogestrinone), an anabolic steroid that is a chemical combination of two other known steroids, gestrinone and trenbolone. "Chemically, it's brilliant," said the chemist. "It's just two things combined in order to bypass the testing. It requires very little change and appears to be relatively easy to synthesize. Any graduate level chemist could make it, although whoever thought of it would be at a much higher level." THG is said to be the fifth known designer steroid, according to steroid expert Charles Yesalis of Penn State University. Sadly, it is hardly going to be the last. Another advantage of THG is that, despite its initial discovery in a syringe, it is a sublingually delivered drug. Instead of an injection, THG can merely be dripped under the tongue a few drops at a time. This makes it easier for a population that tends to shy away from needles and for those who wish to disguise their use. It is unthinkable that someone would pull out a needle in a baseball clubhouse. I can certainly imagine someone sneaking a dropper into his mouth with hardly a second look. The "cream" is the more complex and, in fact, appears to be the more effective of the two substances promulgated by BALCO. Based on Androgel, a prescription topical application of pure testosterone, "the cream" is chemically identical to natural testosterone and can only be tested for using a reference. "There's a range that people have to be considered normal," said the pharmacist. "If you get above that range, there's a likelihood that you're using some outside supplementation of the natural process." Androgel itself was subject to stringent testing before FDA approval and according to those documents, reviewed by our pharmacist, it's incredibly effective. "It looks to be extremely fast acting. It gets a great deal of the active ingredient to the target regions despite being a topical application." Topical application means that it can be rubbed on the skin, normally the upper back. Barry Bonds and Gary Sheffield have both described rubbing "the cream" on joints, which would call its absorption into question. "Steroids are actually primitive," the chemist told me. "They've been around for decades and are relatively well known. Until some smart guy developed THG--and let's face it, that guy is good and likely rich now--there hadn't been a new steroid on the market since the late eighties." Facing increased testing and wider knowledge of the side effects, athletes have moved on. The Next Step "Forget steroids," the player told me in 2003. "They can test for those. They can't test for growth hormone." It was a chilling conversation I had with a baseball player. It's worse when I tell you that it was a high school baseball player carrying a vial of Serastim in his backpack. Designed to help children with hormonal disorders and identical to natural human growth hormone, Serastim is now the prescription of choice for many athletes. Yes, I said prescription. "It's not widespread, like an epidemic," said the pharmacist, "but it worries me that I see it at all. It started with parents that just wanted their kids to be taller, then expanded. Now they want their tall kid to be taller for basketball or stronger for football or baseball. This is not cheap and there has to be some doctor willing to go along with it. I'd guess it's mostly money driving it. Doctors take what amounts to a bribe. The parents see their kid as the next Michael Jordan, so what's a few thousand dollars if it leads to a million? "There's no review of it, so there's no way to catch it. Most places can't test for it and so few kids get tested. In professional sports, it's another cat-and-mouse game. They use, they mask, they hope they don't get tested and if they do get tested, they hope they don't get caught." Human growth hormone, another compound that Jason Giambi admitted using, has long been suspected of being widespread in baseball. "If people ask me if players use steroids, I used to honestly say no," said one athletic trainer, who declined to be named in this article. "I didn't think we had that many stupid guys. I thought they'd all moved on to HGH or something newer and better." HGH, in forms like Seristim and Nutropin, are created by advanced genetic techniques and are chemically indistinguishable from naturally occurring hormones. Dr. Lewis Black told me in his BP Radio interview that tests for HGH are difficult and that instead of looking for a drug, as is normal testing procedure, testers are likely actually looking for metabolic byproducts. HGH testing was said to have had its first run last summer in Athens, but according to sources, the test is dubious at best. There were no positive tests. One source told me that "there's a primitive test, but it'd get beat in court. It's a good first step and a nice scare tactic. They're keeping the samples in hopes that the test gets more reliable, more sensitive." Beyond HGH are more drugs, like Insulin Growth Factor (IGF), Mechano Growth Factor (MGF), luteinizing hormones, EPO, prescription drugs such as Serophene, modafinil, and literally hundreds of others. "It's not going to stop," said a major league player. "It's a question of limiting it. People cheat in everything, but it has to be painful when you get caught. Pitchers scuff, batters cork, and that's part of the game. Drugs are the same thing, just way worse." The catch-me-if-you-can game of abuser and tester will continue. One upcoming challenge is that of further genetic advances, leading to more substances that are chemically indistinguishable from naturally occurring substances, such as HGH, or even making genetic alterations that lead to competitive advantages. Testers are working to stay ahead of the science. Scientists at the French National Doping Laboratories report that they can detect EPO made by a monkey that had been genetically altered to produce performance-enhancing levels of the drug by its own body. While this may sound like so much science ficton, it is frighteningly close to reality. If a monkey can be made to produce EPO 'naturally', it is likely that some competitor is willing to be a guinea pig, hoping that he can be the next Lance Armstrong. If it works with EPO, it will work with hGH, LH or almost any other hormone. It would be a natural assembly line creating illegal drugs and likely a generation of athletes that are literally superhuman. The side effects, however, could be just as astounding. The scientists that first try to build a sports Superman are just as likely to build Frankenstein's monster, doomed to failure or worse. Changing The Game While some players have now admitted to abuse of IPEDs, there has been no doubt all along that the game has a problem. During 2003, MLB conducted what was known as survey testing. Under terms negotiated in the current CBA, baseball randomly tested players to determine the percentage of players that used IPEDs. This testing led to 83 positive results, a figure of just over five percent. This number was high enough to trigger further testing, this time with identifiable results and proscribed penalties. While this program has been widely disparaged for spotty testing, weak penalties, and a very limited set of banned substances, it remains better than what came before. Would stronger testing with more severe penalties impede the spread of IPEDs? There are two test cases. In the minor leagues, there has been no reduction in positive tests over the past three seasons, according to baseball sources with knowledge of the testing results. In the summer of 2003, minor league players participating in the Olympic qualifying tournament were subjected to Olympic standards. Two positive tests were returned and two other players left the team. There is speculation that some turned down invitations, knowing that additional testing would leave them open to penalty. The two players who had positive tests, Angels reliever Derrick Turnbow and Nationals outfielder Terrmel Sledge, are now banned from international competition, but both played in organized baseball in 2004 without further penalty. Now that there is no question that two of the top names in baseball used, either knowingly or unknowingly, IPEDs, the question to be analyzed is: what do these drugs do and how do they help a player or pitcher? Most IPEDs have the goal of either increasing muscle mass, thereby adding strength, or retarding muscle breakdown, reducing fatigue and recovery time. There is no question that these chemicals are effective at their stated goal, albeit with significant complications. Does a stronger player hit the ball harder, swing the bat faster, throw the ball farther or faster, or reduce fatigue significantly enough to change the game or his ability? The question simply has not been adequately answered. Since credible studies cannot be done using humans, instead researchers are forced to use proxies. If steroids make players stronger, do stronger players hit better? Do reduced recovery times help a pitcher get more wins? Kerry Rosenboom, the strength coach at Wichita State University and owner of Rosenboom's Weight Training for Baseball program, believes the effects are overstated. "I can get the same results as drug users with a smart workout program," said Rosenboom in a BP Radio interview. "These guys are putting themselves at risk for incremental gains. It's lazy, but it's also stupid." Surprising to many is that pitchers may actually be helped more by IPEDs than hitters. The image of a steroid user in baseball is the muscle-bound slugger with bulging biceps and pronounced veins. Few pitchers meet that stereotype. Pitchers go out every fourth or fifth day--more for relievers--and pitch to what is called muscle failure, the state where the athlete is unable to adequately complete the task any further. Recovery for a normal starting pitcher takes about 72 hours, going from a "failed" state to "ready," a change of roughly 70% of total capacity. Some pitchers that have had their recoveries tracked have been able to recover in 48 hours. "That full day is a huge advantage," said pitching coach Tom House. "That guy is going to be stronger at the end of an outing and at the end of the season." The use of IPEDs, such as insulin or anabolic steroids, could accelerate the recovery process enough to move from the normal 72 hours to the exception 48 hours or less. The acceleration for an exceptional athlete might not be as much on a percentage basis, while the actual gain might be geometric. There is speculation that for hitters, the true advantage is that a batted ball travels farther. Absent any real evidence or scientific study that a stronger hitter is better, there are few ways to adequately test this assertion. One statistic often asserted is that Barry Bonds has hit more 450-foot home runs over the last five years than he had for the rest of his career. Having hit more home runs in the last five years than anyone, it doesn't appear that Bonds has increased his percentage of long home runs. He's merely increased the rate at which he hits home runs. Is that increase in rate something outrageous enough to cry foul? Bonds has averaged 37 home runs per season over his career. He hit 46 home runs in 1993, his first season in San Francisco. People fond of saying that Bonds' physique has changed significantly seldom point to any gain in 1993. Bonds has only surpassed that 1993 total in two seasons, 2000 and 2001. Measures of bat speed have significant accuracy problems, yet even these point to Bonds not having any IPED advantage. Two of the three highest bat speeds recorded by ESPN in 2001 belonged to Alfonso Soriano and Luis Gonzalez. Instead of muscle-bound, these players are more likely to be described as "lanky" or "wiry." Soriano is often compared to Hank Aaron himself, especially for his quick wrists and easy swing. Aaron, a worthy Home Run King if ever there was one, was hardly a stranger to performance enhancements. Peter Gammons recently wrote about the use of amphetamines in baseball, following work by Tom Verducci that has implicated nearly every great player from the '50s and '60s. Aaron, along with Pete Rose, Mickey Mantle, and others have all been accused of using "red juice" or "greenies." Even today, few players will touch the field without using something, whether that something is a protein shake, herbal supplements, a strong pot of coffee, or something more sinister. Nothing in the records of the two players at the forefront of the BALCO scandal truly stands out as amplified by their use of these substances. Giambi's health problems, from patellar tendonitis (a common malady among steroid users) to his benign tumor, should be a cautionary tale for any who might see an easy road to stardom through a vial. Of course, his multi-million dollar contract makes for a strong counterargument. Bonds' numbers from 1999 onward are often quoted as wildly out of line, but taking his dramatic 73 home-run season out and replacing it with his career average of just 37 homers only makes his numbers slightly less eye-popping. Instead of 703 homers, Bonds would have 667. He'd still be ahead of Willie Mays and still within reach of Babe Ruth. Perhaps Bonds' 2001 season can be credited to the use of some substance, but no less an authority than Aaron stated "I know that you can't put something in your body to make you hit a fastball, change-up or curveball." Nevertheless, these two players--and surely others, up to the 83 that failed testing in 2003 and more that passed through use of non-testable substances or effective masking--are now tainted. There is no need for asterisks in the mind of the public. However, these players apparently passed the drug testing procedures in 2004. No major league player failed a test as far as can be told. It's unlikely that in today's media environment--where grand jury testimony is fodder for front-page stories--that a positive test could have been kept secret. Without more scientific studies on the effects that steroids have on the game, we're left with guesses. Baseball's failure to fund any such studies is on par with their scientific failures. In 2004, MLB established its first funding for research using only $100,000 in grants. That's pathetic. An Uneasy Solution In the end, I find myself at a place I have never been. I support the position of Bud Selig wholeheartedly. I respect the job that the Players Association has done in protecting the rights of players and improving their condition. In this instance, I feel that the duty of the union is in conflict with the best possible solution. It is decidedly not in the best interests of players to give away a right of privacy, to risk their very jobs based on flawed testing, or to give the Office of the Commissioner any further power outside of the collective bargaining process. It is, however, in the player's best interest to protect the game that pays so many of them so richly. It is in the best interest of the players to give fans what they overwhelmingly want, which is some sense, even flawed, that the game punishes those that break the rules, even when those rules are unwritten. The genie will not go back in the bottle and even a testing program that could approach perfection would not correct the perception that the stronger, faster and taller athletes hold some chemical advantage. Every great leap forward, every fluke season, every singular event is going to be greeted by some hard-hearted cynic that will throw drugs into the discussion. No 500-foot home run, no corn-fed draft pick with 20-inch biceps, and no flamethrowing 100-mph closer is going to avoid that particular slime. In attacking the perception, baseball must accept its societal responsibility. The unprecedented opportunity for education happens each time ESPN or Fox puts a microphone in front of a player, coach, or owner. Perhaps instead of Al Leiter saying "butt" and doing jumping jacks, he could crack a baseball into a frying pan and remind us that "this is your game on drugs." Baseball must put its message to the fans: "We're clean. You should be, too." Baseball should also become a global partner in the fight on performance enhancing drugs. In fact, baseball should invite in an organization such as the World Anti-Doping Agency (WADA) to administer its program. Victor Conte may call the Olympics a "chemical circus" and a "fraud of the highest order," yet there is no doubt that the Olympics and its agencies are years ahead of Major League Baseball in administering a testing program with appropriate penalties. Selig's public pronouncements, as well as the threat of government intervention, forces this from a bargaining issue to an immediate crisis. The Commissioner cannot force the issue through without giving something back, while the Players Association needs to protect the rights of its players. My solution is hardly perfect, but in fact there is no real solution to the problem. A testing program will not eliminate the use of illegal drugs, it will only force the users further underground. Users will remain, for the most part, steps ahead of testers due to the economics of the situation and the jackpot-type payoff. My solution, instead, is simple and practical. The players must agree to a testing program, run by an outside agency with guarantees of professionalism and confidentiality, along the lines of the current minor league testing program. The program must have both a random protocol and a probable-cause protocol, all while maintaining the privacy of players. Knocks on the door at midnight in the offseason should not occur. Penalties must be the same as for illegal recreational drugs and patterned on the NFL's policy, with significant suspensions, stringent follow-up programs, and at some point, a cut-off where repeat offenders are removed from the game. In the end, there is no realistic reason to expect more from the game of baseball than we do from our society as a whole. There is no winner in a "War on Drugs." There is only a hope for a dente or a public relations victory.