NYT:

Three hours into a conference held Monday by Major League Baseball on human growth hormone, the real question of the day emerged when officials from the commissioner’s office and the players union wondered aloud about how effective the current blood test for human growth hormone was if no one had tested positive.

In the wake of last December’s Mitchell report, Commissioner Bud Selig said he would bring together leading experts in the field of performance-enhancing drugs to discuss the barriers of testing for human growth hormone.

HGH is not a performance-enhancing drug. Why is MLB doing this? The same reason I have to attend diversity training: to give the appearance of solving a problem that the public cares about. And in the case of growth hormone, public opinion is at odds with the scientific consensus.

No one would believe MLB if it stood up and stated what exercise physiologists have long known: that there are no ergogenic effects from using HGH. The response would be, “MLB is refusing to fight drugs!” They can’t win that battle any more than throwing a ball around circle to discuss racial feelings is going to cure Klansmen of racism. So, we live this bizarre fiction that HGH does work and that it is worth stopping, despite the fact that it runs counter to findings of scientific studies.

I guess I can’t blame MLB. It’s the cheapest way to fight a public relations problem—that’s all this is. And the sad part is that HGH’s prohibition signals to potential users that it works, and the drug has many bad side effects. If anything, the war on growth hormone will do more harm than good. As I have suggested before, the best solution is to legalize it.

Hmmm…

A federal indictment unsealed Wednesday charged that unidentified agents for baseball players steered clients to a California physician linked in media reports to supplying Troy Glaus and Scott Schoeneweis with illegal performance-enhancing drugs.

No players or agents were mentioned by name in the 11-count indictment returned by a grand jury against Dr. Ramon Scruggs and two of his alleged associates at the New Hope Health Center in Costa Mesa, Calif….

The indictment, dated March 5, was unsealed in U.S. District Court in San Jose, Calif. It contains counts involving distribution of steroids, conspiracy, misbranding drugs, money laundering and conspiracy to commit money laundering. The indictment covers activity from September 2000 to May 2003, and charges the defendants with illegally distributing drugs to baseball players, law-enforcement officers and others.

“It was a further part of the conspiracy that, on occasion, sports representation agents for professional baseball players referred their client-players to defendants Scruggs, Danto and MacPherson for the purpose of obtaining anabolic steroids and other drugs which those individuals knew to be banned by Major League Baseball and therefore unavailable to the players through lawful medical channels absent the illegal prescriptions provided by Scruggs,” the indictment said.

I’m heading out the door to catch a plane to Memphis, so I don’t have much time. But, I want to briefly comment on the 50-game suspension of Braves prospect Jordan Schafer for violating MLB’s drug policy in regard to human growth hormone. I’ll offer a few thoughts.

— What the hell is this kid doing? Growth hormone doesn’t improve athletic performance, and it is very bad for you. It’s funny that I have yet to see any mainstream media bring this up, even though this fact was discussed in a widely-covered Congressional hearing two months ago. Maybe Jordan should be reading Sabernomics more and driving his Hummer less.

— When it comes to Schafer the baseball player, I’ve never seen what all the fuss is about. He could be good or drift off into nothing. His numbers aren’t that eye-popping and he is young. He is not good enough to garner the media attention he has been getting.

— The fact that no one will say how he was busted makes me think that he has been ratted out by a dealer. Maybe it’s someone we have already heard of, or it could be that this is just the first of several names to come.

UPDATE: Kevin Goldstein at Baseball Prospectus write the following.

Stories are beginning to come out of an investigation of Schafer and other Braves teammates that led to a confession from Schafer, but it sounds like this could get ugly, if these early stories are true.

Possibly, but keep in mind that early news reports are often tainted by incorrect rumors.

— What does the future hold for Schafer? This is going to be tough to shake, because the first time he doesn’t perform up to his hype—something that is likely to happen anyway—people are going to say, “see, he’s off the drugs.” He might even believe it. Damn placebos!

— Should Schafer be punished for using growth hormone, even though it lacks performance-enhancing benefits? Absolutely. The rules state you can’t do it. Corking a bat doesn’t increase the distance that you can hit a ball, but it is against the rules to do so. The rules must be enforced.

— Are you having trouble following your favorite Braves blogs from day to day? Check out The Tomahawk. It contains snippets and links to blog posts and Braves news.

— If you are looking for an easy way to link to all of my commentary on the lacking effectiveness of human growth hormone, I have now created a separate category for these posts.

— Charles at Cosellout uses the Sports Illustrated archives to track the magazine’s coverage of performance-enhancing drugs going back to 1969.

In the months to come we will be cataloguing their articles according to special categories as part of an SI Vault Series. Given the current climate on the subject, performance enhancing drugs (PEDS) seemed like a wonderful place to start. As accountability is being requested from players to managers to owners, there is one contingent that has answered to no one: The MEDIA. It is important for the public to know the same question asked of everyone else: “what did they know”? Given SI’s historical reputation America’s #1 magazine, it goes without saying that if Sports Illustrated printed it, then the rest of the sports media knew about it.

— Michael Shermer has an article in Scientific American that discusses the prisoner’s dilemma game that motivates steroid use in all sports (thanks to Freakonomics and The Sports Economist). Readers of The Baseball Economist (or bargain hardback) will recall the direct application of this game to baseball in Chapter 9 (The Steroids Game). To end doping in sports Shermer states that any solution must correct the incentives that lead players to use.

To end doping in sports, the doping game must be restructured so that competing clean is in a Nash equilibrium. That is, the governing bodies of each sport must change the payoff values of the expected outcomes identified in the game matrix. First, when other players are playing by the rules, the payoff for doing likewise must be greater than the payoff for cheating. Second, and perhaps more important, even when other players are cheating, the payoff for playing fair must be greater than the payoff for cheating. Players must not feel like suckers for following the rules.

I agree; and here is my solution for changing the payoffs in the New York Times.

In an effort to clean up the game, it is tempting to suggest the standard solutions that strengthen old rules and increase monitoring and punishments. The problem is that the scofflaws are always one step ahead of the police. We need a deterrence system that uses incentives to limit drug use.

Baseball should stop punishing steroid users with suspensions and small fines. Instead, the sport needs a system of significant fines and bonuses. The revenues generated by cheaters under the new fine-and-bonus system would be distributed to the players who passed their tests. In addition to punishing players who cheat, this system would have the advantages of rewarding players who stayed clean and of encouraging players to police each other. Players would continue to play while being punished, so that fans did not suffer for player sins.

More here. Steven Levitt favors a proposal that stores blood samples over a long period of time. I don’t think it is possible in baseball given the fear of tampering and alternate uses. The players will never allow this, and I don’t blame them for their opposition. In a world where I don’t blindly trust my mechanic, why would I trust a lab holding a blood sample that could ruin my livelihood?

Headline: Growth hormone doesn’t boost athletic abilities: HGH may actually impair performance, review of studies finds

While growth hormone adds some muscle, it doesn’t appear to improve strength or exercise capacity, according to a review of studies that tested the hormone in mostly athletic young men.

“It doesn’t look like it helps and there’s a hint of evidence it may worsen athletic performance,” said Dr. Hau Liu, of Santa Clara Valley Medical Center in San Jose, Calif., who was lead author of the review.

Of course, this doesn’t stop the AP reporter from offering several qualifiers.

But the new research has some limitations and sheds no light on long-term use of HGH. The scientists note their analysis included few studies that measured performance. The tests also probably don’t reflect the dose and frequency practiced by athletes illegally using the hormone. Experiments like that aren’t likely to be conducted.

“It’s dangerous, unethical and it’s never going to be done,” said Dr. Gary I. Wadler, a member of the World Anti-Doping Agency and a spokesman for the American College of Sports Medicine.

Consequently, those in the field have to depend on such reviews or “what we hear on the ground,” he added.

You know, I don’t recall the media being so vigorous on catching up on the science when all of the stories were reporting on growth hormone as a performance-enhancer.

There is no doubt that the perfect study on the subject has yet to be done, nor will it ever be done. But, the studies that have been done lead me to believe that were such a study to be done I would expect it to find minimal ergogenic effects. It’s not just that some empirical studies have been done on strength, but that when the muscles themselves are studied, they are developing differently from normal muscle. Thus, when we hypothesize about larger doses, I think the current studies give us a good idea about would occur.

The problem going with WADA scientist Gary Wadler hears “on the ground” is that in uncontrolled experiments, the placebo effect rears its head.

I hear this question quite a bit when I point out that growth hormone does not improve athletic performance. One plausible explation is that players are not well informed on the subject, given that most of their information comes from drug pushers (see Andy Pettitte’s and Chuck Knoblauch’s depositions) and the ill-informed media. But, Justin Wolfers at Freakonomics points to a new study that offers another possible explanation: the placebo effect.

A placebo is a benign substance used in medical trials to control for psychological responses to drugs. For example, a drug given to arthritis patients may cause them to feel better just because they expect to feel better, not because the drug actually worked. Similarly, players who use human growth hormone may notice themselves feeling stronger and more productive after taking a substance that is supposed to have this effect. A colleague of mine who conducts clinical trials on athletes tells me it is common for his placebo subjects to insist they are getting the real stuff.

It turns out that the placebo effect of human growth hormone could be even stronger than previously expected. New research by economist Dan Ariely finds that the placebo effect is exacerbated by the price of the drug.

A higher price can create the impression of higher value, just as a placebo pill can reduce pain.

Now researchers have combined the two effects. A $2.50 placebo, they have found, works better one that costs 10 cents.

The finding may explain the popularity of some high-cost drugs over cheaper alternatives, the authors conclude. It may also help account for patients’ reports that generic drugs are less effective than brand-name ones, though their active ingredients are identical.

Why is this relevant? Human growth hormone is very expensive relative to other performance-enhancing drugs. According to the Mitchell Report, Kirk Radomski charged his clients $1,600 for a one-month supply of human growth hormone, while he only charged $400 for Winstrol.

Radomski typically paid at least $1,000 or more for one “kit” of human growth hormone, which included seven vials of distilled water and the same number of packages of lypholized human growth hormone powder, but the price depended on availability. He generally resold kits for $1,600 each, but in some instances charged less depending on his relationship with the player (pp. 144–145).

Radomski believed he made between three and five sales to [Chad] Allen involving Winstrol, testosterone, and Deca-Durabolin. According to Radomski, Allen could not afford human growth hormone…. Radomski mailed a one or two-month supply of Winstrol to Allen at his home in Texas. Allen paid Radomski approximately $400 by check (pp. 225–226).

Players who use performance-enhancing drugs have a strong reason to believe that a drug that is four-times as expensive as a common anabolic steroid is also going to improve performance. Thus, in light of Ariely’s study, it is not surprising that some players have convinced themselves that human growth hormone is responsible for improved performance.

Yesterday, AJC Braves beat writer David O’Brien featured an interview with Chipper Jones and Tom Glavine about blood testing for human growth hormone in baseball. I don’t want to get sidetracked by the fact that it would be a total waste of resources to test for HGH, or that it would make more sense to allow it than to police it; instead, I want to focus on the player’s decision to submit to testing.

I believe that Chipper Jones echoes the sentiments of many major-league baseball players.

“I don’t care,” the third baseman said Tuesday. “I’m not on anything, so it doesn’t bother me. The only people I would say who would object would be people afraid of needles, or who are on something.”

A player who is clean has every reason to want testing, but users may favor testing as well. A substance that is performance-enhancing gives users an edge over non-users, which translates into higher salaries. Players face the choice of using to keep their edge or abstaining and settling for compensation less than equally-talented players who use. Thus, there is a strong incentive to use. In a world where all players use, the end result is that players are no better than one another, yet they incur the expense and health consequences of using. Therefore, it makes sense for players to want stringent testing to stamp out this behavior.

However, there is another side to this, and Chipper is well aware of it.

He added, “I’m sure the players association would have something to say about it.”

Jones was asked about the issue three days after Yankees star Derek Jeter said in a radio interview that he wouldn’t object to a blood test, since players already are required to have blood drawn for physicals during spring training.

“You’re talking about individual guys coming out and saying they wouldn’t mind,” Jones said. “I’m sure if [players union head] Don Fehr sat us down and listed the pros and cons, and what the majority of players thought, it might be different.”

Former union representative Tom Glavine elucidates the cons.

“I’m not going to say it’s never going to change, but I see it as a very thorny issue right now,” Glavine said. “There’s too many potential problems, too many question marks.

“It’s potentially opening up a big can of worms. There’s the potential for so many problems with the way that it’s handled, the way it’s stored.”

Glavine said he could envision a player’s career being ruined by blood sample being tampered with by someone with a vendetta.

“On a personal level, it scares me to think of somebody having my blood and the potential to tamper with it down the road,” Glavine said. “Your career could be ruined, and you wouldn’t be able to do anything about it.”

Urine is urine and blood is blood. These substances yield more information than just the use of performance-enhancing drugs. Players are right to be suspicious about the motives of owners, players, and other associates. This is why I suggest handing over all testing and enforcement to the players. Here is my Op-Ed in the NY Times, and here is post with further explanation. I also discuss this in Chapter 9 of my book.

It’s nice to see the scientific consensus on human growth hormone (HGH) finally reach the general public.

The House Committee that on Wednesday is expected to hear the differing viewpoints of Roger Clemens and Brian McNamee did its pharmacology homework Tuesday, holding a hearing on the “Myths and Facts about Human Growth Hormone, B-12, and Other Substances.”

The consensus from the four doctors who testified: Neither HGH nor vitamin B-12 appears to help athletic performance very much, although much more research is needed on HGH, which also has a litany of unappealing side effects.

“There is no credible scientific evidence that growth hormone substantively increases muscle strength or aerobic exercise capacity in normal individuals,” said Dr. Thomas Perls, director of the New England Centenarian Study at the Boston University of Medicine.

It’s only been ten months since I started my campaign.

A question that people often ask me is: if human growth hormone doesn’t enhance performance, then why do athletes use it? My response has been that athletes don’t have the proper information. My guess is that men like Kirk Radomski are spreading false information to push their product.

In the next issue of Time Magazine, Sylvester Stallone weighs in on his own use of testosterone and GH. It is a prime example of how informed users may be.

Playing a guy who acts with only his eyes and his biceps is harder than playing a fast-talking, earnest boxer, especially on a 61-year-old body. Which was one of the reasons Stallone wanted to do it. He pumped up to a freakish 209 lbs. (95 kg); in Rambo II he weighed only 168 (76 kg). And, he insists, he did it without steroids, though with the help of a prescription testosterone. “HGH [human growth hormone] is nothing. Anyone who calls it a steroid is grossly misinformed,” he says. “Testosterone to me is so important for a sense of well-being when you get older. Everyone over 40 years old would be wise to investigate it because it increases the quality of your life. Mark my words. In 10 years it will be over the counter.” He was in such great shape, it freaked out his co-star, Julie Benz. “I’m a runner. I sprint. And I’m extremely competitive. And he blew past me every time. And he doesn’t run at all. He’s that focused,” she says. [Emphasis added]

HGH isn’t nothing. It won’t help you play sports, but it has serious effects on the body. Has he looked in the mirror lately? I’ll give him the benefit of the doubt that he was referring to its strength benefits.

But, it is his comments about testosterone that blew me away. Testosterone isn’t a steroid?

From Wikipedia:

Testosterone is a steroid hormone from the androgen group. In mammals, testosterone is primarily secreted in the testes of males and the ovaries of females, although small amounts are also secreted by the adrenal glands. It is the principal male sex hormone and an anabolic steroid.

Definition of testosterone from The American Heritage Medical Dictionary:

A steroid hormone and the most potent naturally occurring androgen that is formed by the interstitial cells of the testes, and possibly by the ovary and adrenal cortex, may be produced in nonglandular tissues from precursors such as androstenedione, and is used in the treatment of hypogonadism, cryptorchism, carcinomas, and menorrhagia.

It’s hard to be this badly informed, especially when you consider that the guy built a career off of using the stuff. Maybe the reporter misunderstood him. I wouldn’t be surprised, because it must have been difficult to decipher a collection of grunts and snarls.

Thanks to Craig Calcaterra for the pointer.

I watched a good bit of yesterday’s Congressional hearing regarding the Mitchell Report. The star of the show was not a person, but human growth hormone (HGH). Bud Selig and Donald Fehr were honest and acknowledged mistakes about the past, but the league and the players union have come along way to develop a system for deterring the use of performance-enhancing drugs. Mandatory random drug testing with fines and suspensions are consistent with what other governing sports bodies employ to deter doping. But the fact that HGH remains undetectable is distracting everyone from the progress that has been made. It is just not that big of a deal. And it pains me that both Selig and Fehr are being blamed for not being able to eradicate a drug that people only think enhances performance.

Here is what Selig had to say.

Senator Mitchell’s report reveals that those who are intent on cheating will continue to search for ways to avoid detection, such as turning to the use of Human Growth Hormone (”HGH”) which is not detectable in a urine test. Perhaps my single biggest frustration in reading Senator Mitchell’s report was in learning that, just as Baseball was putting in place an effective testing program aimed at steroids, HGH use was growing. Just as we have seen our programs effectively reduce the use of steroids in Baseball, I am committed to stop the use of HGH in our sport, as well. Along with the National Football League, Baseball is funding an effort by Dr. Don Catlin, one of the leading drug testing experts in the world, to develop a urine test for HGH, and we will be convening a summit of the best minds in sports and science to develop a strategy to address the use of HGH by players. Just recently, we have joined with the United States Olympic Committee in a new, longterm program of research on performance enhancing drugs. Our initial commitment is for $3 million in funding. When a valid, commercially available and practical test for HGH becomes reality - regardless of whether the test is based on blood or urine - Baseball will support the utilization of that test.

A $3 million initial commitment to detect a drug that even the Mitchell Report declares to be ineffective (pp. 9-10)? [See I Don’t Worry about HGH in Baseball, and Neither Should You for further evidence.] Selig may be acting on many of Senator Mitchell’s recommendations, but he’s got no one to blame but himself on this one. I’d much prefer that MLB allow HGH use, spend some money educating players on how this stuff doesn’t work—and please no more scare-tactic commercials with deflating balls or crumbling statues; these do nothing—and then devote the bulk of those resources to the RBI program. Take HGH off the banned list and send a credible signal to players that this stuff doesn’t work (my plan).

Fehr seemed even more bothered than Selig by the fact that there are not reliable tests for HGH.

Senator Mitchell pointed out that our JDA is indeed working to detect the use of detectable performance enhancing substances. With respect to steroids, the numbers are clear: We have conducted more than 3,000 tests in each of the last two years, and the number of steroid positives we have had during that time is five. More precisely, during 2006 and 2007 we conducted 6,252 tests, and there were five steroid positives (two in 2006 and three in 2007).

But what about undetectable PEDs, most notably Human Growth Hormone (HGH)? We share Senator Mitchell’s concern, and we have acted. Starting in January 2005, we banned HGH. We do not test for HGH, because there is no scientifically reliable urine test available. As soon as one is, our agreement states that HGH testing for players will begin automatically.

Even in the absence of a test, our commitment against HGH is no less strong than our commitment against steroids. We have developed and agreed to procedures which allow players to be suspended for HGH use based on evidence other than a positive test, a so called “non-analytical” finding. In both 2006 and 2007, players were suspended on that basis.

Of course, it is possible that a valid blood test for HGH will be developed before a valid urine test. However, as Senator Mitchell has indicated, if there is a blood test developed in the near future it may well be of very limited utility; i.e. a player will need to have used HGH a very short time before the test in order for it to show up. In addition there are very serious issues involved with blood tests for athletes, particularly on competition days, and in baseball we play nearly every day. As of now, no major professional sport has blood testing for PEDs. If and when a blood test becomes available, we will consider it based on the facts then available.

However, the biggest problem with HGH is very probably its availability to the American public. Anti-aging clinics and others openly advertise in magazines stressing the benefits of HGH. We will continue to take steps against HGH, but this is a societal, not just a baseball problem. If we did not know that before, the investigations into internet pharmacy sales of HGH made public over the last year have made this apparent.

All one need do in order to appreciate the magnitude of this problem is to go onto Google’s website and type in the words, “Where can I buy HGH?” A few days ago this search returned 349,000 options in a quarter of a second. Advertisements for HGH can be found in newspapers and magazines nationwide. For example, in the current Continental Airlines magazine, on page 99, there is an advertisement with the following headline: “Choose life. Grow young with HGH.” Abuse of HGH and other licit (and illicit) pharmaceuticals is not just baseball’s problem.

And I feel for Fehr, because he can’t come out and say that HGH doesn’t work, even if he is aware that of this—I believe that both Selig and Fehr know this. The committee would have laughed him out of the room because he is the enemy. This runs counter to every thing we “know”. He might as well have said that Neil Armstrong never walked on the moon. Instead, he provided a comical advertisement that puts the drug on the same footing as ionic bracelets. Nice tactic, by the way.

And what about the children for whom the representatives showed so much concern? What about them?! Do children buy growth hormone to improve performance? According to Kirk Radomski, the going rate for the drug is $1,600 for a one-month supply. That’s more than most parents’ house payments. Teenagers are not buying HGH to pump up anymore than they are buying $200 bottles of mail order wine to get drunk. There is the role model issue, but this just doesn’t concern me. The world is full of immoral people. Teach your kids right and wrong and get over it. I’m more worried that my children will be influenced by friends and family than baseball players. Anyway, I find Tony La Rusa to be more offensive than any of the players he has ever managed, but I think it would be a bad idea to hold congressional hearing on rampant arrogant jackassery in sports. This is a bigger problem in the role model department for professional sports.

The fact that HGH is undetectable is a problem only if it enhances performance. The evidence is that it doesn’t, so let’s move on. The war on HGH serves as the drug’s best advertisement, and Congress just bought anti-aging clinics a 30-second spot during the Super Bowl. At the next hearing, I hope that Congress invites some clinical researchers who have studied the substance to weigh in.